The fracture, patient wishes and co-morbidities will be considered. The aim is to restore normal anatomical alignment of the distal radius. Patients are then referred to orthopaedics (or plastic surgery) for review and decision on definitive management. For those with extra-articular fractures most will attempt a closed reduction and cast immobilisation with appropriate analgesia (e.g. The majority patients presenting with fractures of the distal radius receive their initial management in ED. They are in part based upon BOAST The Management of Distal Radial Fractures 2017 and BSSH Best Practice for Management of Distal Radial Fractures2018. Fractures that are unstable in cast with progressive dorsal angulation and loss of radial height should also be considered for operative intervention. Operative options include ORIF (normally volar approach with volar plate), external fixation and percutaneous K-wires.īelow represents a general framework (though a simplified one) on the management of these fractures. These include fractures that are intra-articular (and displaced), significantly comminuted or show significant radial shortening. Management of distal radius fractures is complicated and depends on a myriad of factors. Surgical fixation is reserved for patients who are likely to have poor functional outcomes from closed reduction and cast immobilisation alone - and in whom surgery would improve outcomes. The goal of treatment is to restore normal anatomical alignment to encourage healing and preserve functionality. They may have dorsal angulation or volar angulation (volar Barton). Intra-articular involvement increases the risk of arthritis and reduced function. Barton fractureīarton fracture describes an intra-articular fracture of the distal radius. Smith's fractures tend to result from a fall onto a flexed hand or a direct blow to the back of the wrist. Tend to be inherently less stable than fractures with dorsal angulation. Refers to a fracture of the distal radius with volar angulation of the distal fragment. ![]() There is an associated fracture of the ulna styloid in around 50% of cases. It is classically caused by a 'fall onto outstretched hand' (or FOOSH - an acronym you will often see in orthopaedic clerkings). ![]() Colles’ fractureĪ type of distal radius fracture defined as an extra-articular fracture of the metaphyseal region of the radius with dorsal angulation (of the distal fragment) and impaction. Intra-articular fractures of the distal radius are called Barton's fractures (described below). In the hand, this describes the palm of the hand.Ĭolles' and Smith's are both classically considered to be extra-articular fractures (fractures that do not involve the articular surface). ![]() Ventral surface: refers to the front or lower side.In the hand, this describes the back of the hand. Dorsal surface: refers to the back or upper side.They are described based on the angulation of the distal radial fragment, as such, you must be aware of two terms: It remains important however to be aware of these eponyms and their meanings. You will find however in practice, at trauma meetings these eponyms are rarely used - instead replaced with a clear verbal description of the radiological appearances of the fracture. Fractures may be described based upon region, displacement, comminution and angulation.Ĭolles' and Smith's are frequently discussed fracture patterns when taught as students.
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