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Orthopaedics
Fracture of the Distal Radius
Built from Tang — Orthopaedic Trauma Vol 1: Upper Extremity
What’s inside
13 sections · 114 slides
Overview
- What this topic teaches you
The distal radius and why it breaks
- A common fracture across a range of severity
- The four measurements that define a normal wrist
- Key radiographic measurements of the distal radius
- AP distance and Lister's tubercle: two more clues
- The distal radioulnar joint: keeping rotation
- The TFCC: the wrist's inner cushion and sling
- Stabilising structures of the distal radioulnar joint
- TFCC tension in rotation; ulnar styloid patterns
- TFCC tension and ulnar styloid fracture types
- The three-column theory of the wrist
- The three columns of the distal radius and ulna
- Melone classification: four fragments, five types
- Melone classification of distal radius fractures
- Reducing a Melone fracture by hand: Agee's steps
- Why ligaments limit closed reduction
- Volar and dorsal radiocarpal ligaments
- How the column theory shapes plate design
- Volar and dorsal locking plate designs
How the distal radius breaks
- Wrist position at impact decides the pattern
- From simple to devastating injuries
Naming and classifying the fractures
- The classic eponyms still heard in the clinic
- Classic eponymous distal radius fractures
- The Fernandez classification: sorted by mechanism
- Fernandez classification of distal radius fractures
- The AO classification: a detailed three-type grid
- AO classification of the distal radius at a glance
- AO classification of distal radius fractures
Assessing the injured wrist
- Clinical assessment at the bedside
- The workhorse: wrist X-rays and the 10-degree view
- The 10-degree lateral wrist projection
- Carpal facet horizon and teardrop angle
- Carpal facet horizon and teardrop angle
- Concentricity, AP distance and DRUJ checks
- Joint concentricity, AP distance and DRUJ assessment
- When plain films are not enough: CT and MRI
Conservative treatment
- When plaster is enough
- The reduction targets that must be met
- Signs the reduction will not hold in plaster
- Casting, follow-up and the danger of early slippage
Surgical indications and goals
- Matching the operation to the Fernandez type (I-III)
- Fernandez types IV and V, and the purpose of surgery
Percutaneous pinning
- Percutaneous pinning: the idea and the setup
- The pinning technique, step by step
- Percutaneous (Kapandji) pinning of a Colles fracture
- Aftercare, tips and pitfalls of pinning
- Pinning plus external fixation, case example
External fixation
- Cross-articular external fixation: the setup
- Positioning for external fixation
- Placing the metacarpal (hand-side) screws
- Metacarpal Schanz screw placement
- Placing the radial (forearm-side) screws
- Radial shaft Schanz screw placement
- Reduction, fixation and avoiding over-distraction
- Reduction and locking of the external fixator
- Over-distraction causing a metacarpal fracture
- Managing associated DRUJ and ulnar styloid injuries
- Side bracket for a DRUJ separation
- The non-bridging external fixator
- Non-bridging external fixation technique
- Bridging versus non-bridging external fixation
Open reduction: palmar approach
- Choosing the palmar or the dorsal approach
- Palmar approach: positioning and incision
- Palmar approach skin incision
- Palmar approach: reaching the bone
- Palmar surgical approach to the distal radius
- Mild dorsal angle, no dorsal compression
- Volar plating of a simple extra-articular fracture
- Mild dorsal angle with dorsal compression
- Locking plate for a defective dorsal fragment
- Correcting a dorsal angle over 15 degrees
- Correcting dorsal angulation with a volar plate
- Intra-articular fractures: fixing the radial styloid
- Radial styloid and volar lip mechanics
- Fixing the dorsal and palmar lip fragments
- Comminuted intra-articular fracture, plate fixation
- Screw position, bone graft and closure
- Treating an associated ulnar styloid fracture
- Distal radius fracture with ulnar styloid base fracture
- Postoperative care and volar-approach pearls
Open reduction: the dorsal approach
- The dorsal approach: when and where
- Dorsal approach skin incision
- Working through the extensor compartments
- Dorsal approach through the extensor compartments
- Dorsal dual-plate fixation
- Dorsal dual-plate fixation technique
- Dorsal dual-plate fixation, case example
Complications and their prevention
- Malunion: causes and how fixation choice prevents it
- Comminuted fracture where external fixation lost length
- Protecting the median nerve and tendons
- Dorsal tendon injury from prominent screws
- Dorsal screw protrusion despite a normal lateral view
- Screws straying into the distal radioulnar joint
- A screw straying into the distal radioulnar joint
Bringing it together
- Numbers worth remembering
- Three principles to remember
- Final takeaways
- References (1/3)
- References (2/3)
- References (3/3)
- Orthopaedic Trauma Surgery — Volume 1: Upper Extremity