Distal radius fracture physical examination: Difference between revisions

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{{Distal radius fracture}}
{{Distal radius fracture}}
{{CMG}} {{AE}} {{Rohan}}
{{CMG}} {{AE}} {{Rohan}}


==Overview==
==Overview==
Patients with distal radius fracture usually appears well. Physical examination of patients with distal radius fracture is usually remarkable for swelling, tenderness, bruises, ecchymosis, deformity  and restricted range of motion of the wrist.  
Patients with [[distal radius fracture]] usually appears well. Physical examination of patients with [[distal radius fracture]] is usually remarkable for [[swelling]], [[tenderness]], [[Bruise|bruises]], [[ecchymosis]], [[deformity]] and restricted [[range of motion]] of the [[wrist]].  


==Physical Examination==
==Physical Examination==
Physical examination of patients with distal radius fracture is usually remarkable for swelling, tenderness, bruises, ecchymosis, deformity  and restricted range of motion of the wrist.  
Physical examination of patients with [[distal radius fracture]] is usually remarkable for [[swelling]], [[tenderness]], [[Bruise|bruises]], [[ecchymosis]], [[deformity]] and restricted [[range of motion]] of the [[wrist]].  
 
{| align="right"
|
[[File:Sign DRF.jpg|300px|thumb|Deformity following distal radius fracture. [https://en.wikipedia.org/wiki/Distal_radius_fracture#/media/File:Distalradiusfracture.jpgSource: By Curtishand - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=4812004]]]
|}
===Appearance of the Patient===
===Appearance of the Patient===
* Patients with distal radius fracture usually appears well.  
* Patients with [[distal radius fracture]] usually appears well.  


===Vital Signs===
===Vital Signs===


* Weak pulse may be seen when associated with polytrauma.
* [[Pulse|Weak pulse]] may be seen when associated with [[polytrauma]].
* Low blood pressure with normal pulse pressure may be present due to compound fracture with blood loss.
* [[Hypotension|Low blood pressure]] with normal [[pulse pressure]] may be present due to [[compound fracture]] with [[Bleeding|blood loss]].


===Skin===
===Skin===
* Skin examination of patients with distal radius fracture includes:
* Skin examination of patients with distal radius fracture includes:
** Bruises
** [[Bruise|Bruises]]
** Ecchymosis
** [[Ecchymosis]]


===HEENT===
===HEENT===
* HEENT examination of patients with distal radius fracture is usually normal.
* HEENT examination of patients with [[distal radius fracture]] is usually normal.


===Neck===
===Neck===
* Neck examination of patients with distal radius fracture is normal.
* Neck examination of patients with [[distal radius fracture]] is normal.


===Lungs===
===Lungs===
* Pulmonary examination of patients with distal radius fracture is usually normal.
* Pulmonary examination of patients with [[distal radius fracture]] is usually normal.


===Heart===
===Heart===
* Cardiovascular examination of patients with distal radius fracture is usually normal.
* Cardiovascular examination of patients with [[distal radius fracture]] is usually normal.


===Abdomen===
===Abdomen===
* Abdominal examination of patients with distal radius fracture is usually normal.
* Abdominal examination of patients with [[distal radius fracture]] is usually normal.


===Back===
===Back===
* Back examination of patients with distal radius fracture is usually normal.
* Back examination of patients with [[distal radius fracture]] is usually normal.


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with distal radius fracture is usually normal.
* Genitourinary examination of patients with [[distal radius fracture]] is usually normal.


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with distal radius fracture is usually normal.
* Neuromuscular examination of patients with [[distal radius fracture]] is usually normal.
* However, some patients may develop neuropraxia of the superficial branch of the radial nerve (Wartenberg's syndrome) and median nerve resulting in decreased sensation of thumb, index and middle  finger.
* However, some patients may develop [[neuropraxia]] of the [[superficial branch of the radial nerve]] ([[Wartenberg's syndrome]]) and [[median nerve]] resulting in decreased sensation of thumb, index and middle  finger.


===Extremities===
===Extremities===
* Wrist examination of patients with distal radius fracture include:<ref name="pmid16376003">{{cite journal| author=Bienek T, Kusz D, Cielinski L| title=Peripheral nerve compression neuropathy after fractures of the distal radius. | journal=J Hand Surg Br | year= 2006 | volume= 31 | issue= 3 | pages= 256-60 | pmid=16376003 | doi=10.1016/j.jhsb.2005.09.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16376003  }} </ref><ref name="pmid20494751">{{cite journal| author=Kleinman WB| title=Distal radius instability and stiffness: common complications of distal radius fractures. | journal=Hand Clin | year= 2010 | volume= 26 | issue= 2 | pages= 245-64 | pmid=20494751 | doi=10.1016/j.hcl.2010.01.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20494751  }} </ref><ref name="pmid24642190">{{cite journal| author=Walenkamp MM, Goslings JC, Beumer A, Haverlag R, Leenhouts PA, Verleisdonk EJ et al.| title=Surgery versus conservative treatment in patients with type A distal radius fractures, a randomized controlled trial. | journal=BMC Musculoskelet Disord | year= 2014 | volume= 15 | issue=  | pages= 90 | pmid=24642190 | doi=10.1186/1471-2474-15-90 | pmc=4234244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24642190  }} </ref><ref>{{cite book | last = Hove | first = Leiv | title = Distal radius fractures : current concepts | publisher = Springer | location = Heidelberg | year = 2014 | isbn = 9783642546037 }}</ref>
{| align="right"
** Swelling
|
** Tenderness
[[File:Dinner fork Deformity.jpg|300px|thumb|Dinner fork deformity following distal radius fracture. [https://en.wikipedia.org/wiki/Distal_radius_fracture#/media/File:Distalradiusfracture.jpgSource: By Todd, Robert Bentley, 1809-1860 - Image from page 732 of "The cyclopædia of anatomy and physiology" (1849)https://www.flickr.com/photos/internetarchivebookimages/20635126888/in/photolist-c91vG3-cpsGi1-xrsqiN/, Public Domain, https://commons.wikimedia.org/w/index.php?curid=63779916]]]
** Dinner fork deformity
|}
*** Dinner fork deformity of the wrist is caused by dorsal displacement of the carpal bones (Colle's fracture).
* [[Wrist]] examination of patients with [[distal radius fracture]] include:<ref name="pmid16376003">{{cite journal| author=Bienek T, Kusz D, Cielinski L| title=Peripheral nerve compression neuropathy after fractures of the distal radius. | journal=J Hand Surg Br | year= 2006 | volume= 31 | issue= 3 | pages= 256-60 | pmid=16376003 | doi=10.1016/j.jhsb.2005.09.021 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16376003  }} </ref><ref name="pmid20494751">{{cite journal| author=Kleinman WB| title=Distal radius instability and stiffness: common complications of distal radius fractures. | journal=Hand Clin | year= 2010 | volume= 26 | issue= 2 | pages= 245-64 | pmid=20494751 | doi=10.1016/j.hcl.2010.01.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20494751  }} </ref><ref name="pmid24642190">{{cite journal| author=Walenkamp MM, Goslings JC, Beumer A, Haverlag R, Leenhouts PA, Verleisdonk EJ et al.| title=Surgery versus conservative treatment in patients with type A distal radius fractures, a randomized controlled trial. | journal=BMC Musculoskelet Disord | year= 2014 | volume= 15 | issue=  | pages= 90 | pmid=24642190 | doi=10.1186/1471-2474-15-90 | pmc=4234244 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24642190  }} </ref><ref>{{cite book | last = Hove | first = Leiv | title = Distal radius fractures : current concepts | publisher = Springer | location = Heidelberg | year = 2014 | isbn = 9783642546037 }}</ref><ref>{{cite book | last = Azar | first = Frederick | title = Campbell's operative orthopaedics | publisher = Elsevier | location = Philadelphia, PA | year = 2017 | isbn = 9780323433808 }}</ref>
*** Reverse deformity is seen in volar angulation (Smith's fracture).
** [[Edema|Swelling]]
** The wrist may be radially deviated due to shortening of the radius bone.  
** [[Tenderness]]
** Restricted range of motion
** [[Dinner fork deformity]]
** Tingling and decreased sensation of thumb, index and middle finger
*** Dinner fork deformity of the [[wrist]] is caused by [[Dorsal|dorsa]]<nowiki/>l displacement of the carpal bones ([[Colles fracture|Colle's fracture]])  
** Decreased sensation over the thenar eminence can be due to median nerve injury
*** Reverse [[deformity]] is seen in [[volar]] angulation ([[Smith's fracture]])  
** Decreased grip and forearm strength
** The wrist may be radially deviated due to [[shortening]] of the [[Radius|radius bone]]  
** Acute carpal tunnel syndrome
** Restricted [[range of motion]]
** [[Tingling]] and decreased [[sensation]] of thumb, index and middle finger
** Decreased [[sensation]] over the [[thenar eminence]] can be due to [[median nerve]] injury
** Decreased grip and [[forearm]] strength
** Acute [[carpal tunnel syndrome]]


==References==
==References==
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{{WH}}
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{{WS}}
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[[Category:Needs content]]
[[Category:Needs content]]
[[Category:Orthopedics]]
[[Category:Orthopedics]]
[[Category:Orthopedic surgery]]
[[Category:Orthopedic surgery]]
[[Category:Primary care]]
[[Category:Fractures]]
[[Category:Fractures]]
[[Category:Bone fractures]]
[[Category:Bone fractures]]

Latest revision as of 21:25, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

Patients with distal radius fracture usually appears well. Physical examination of patients with distal radius fracture is usually remarkable for swelling, tenderness, bruises, ecchymosis, deformity and restricted range of motion of the wrist.

Physical Examination

Physical examination of patients with distal radius fracture is usually remarkable for swelling, tenderness, bruises, ecchymosis, deformity and restricted range of motion of the wrist.

Deformity following distal radius fracture. By Curtishand - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=4812004

Appearance of the Patient

Vital Signs

Skin

  • Skin examination of patients with distal radius fracture includes:

HEENT

Neck

Lungs

Heart

Abdomen

Back

Genitourinary

Neuromuscular

Extremities

Dinner fork deformity following distal radius fracture. By Todd, Robert Bentley, 1809-1860 - Image from page 732 of "The cyclopædia of anatomy and physiology" (1849)https://www.flickr.com/photos/internetarchivebookimages/20635126888/in/photolist-c91vG3-cpsGi1-xrsqiN/, Public Domain, https://commons.wikimedia.org/w/index.php?curid=63779916

References

  1. ↑ Bienek T, Kusz D, Cielinski L (2006). "Peripheral nerve compression neuropathy after fractures of the distal radius". J Hand Surg Br. 31 (3): 256–60. doi:10.1016/j.jhsb.2005.09.021. PMID 16376003.
  2. ↑ Kleinman WB (2010). "Distal radius instability and stiffness: common complications of distal radius fractures". Hand Clin. 26 (2): 245–64. doi:10.1016/j.hcl.2010.01.004. PMID 20494751.
  3. ↑ Walenkamp MM, Goslings JC, Beumer A, Haverlag R, Leenhouts PA, Verleisdonk EJ; et al. (2014). "Surgery versus conservative treatment in patients with type A distal radius fractures, a randomized controlled trial". BMC Musculoskelet Disord. 15: 90. doi:10.1186/1471-2474-15-90. PMC 4234244. PMID 24642190.
  4. ↑ Hove, Leiv (2014). Distal radius fractures : current concepts. Heidelberg: Springer. ISBN 9783642546037.
  5. ↑ Azar, Frederick (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323433808.

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