Updated: 10/11/2017

Distal Radius Fracture

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Snapshot
  • pictureA 61-year-old woman presents to the emergency room complaining of left wrist pain after falling on her outstretched hand. Her medical history is notable for diabetes and osteoporosis. On exam, her left wrist is swollen and tender to palpation. She is unable to flex or extend her wrist due to pain.
Introduction
  • Clinical definition
    • forearm fracture of the distal end of the radius
      • considered 1 of 3 common "fragility fractures" associated with osteoporosis
        • other 2 are
          • vertebral compression fractures
          • femoral neck fractures
      • "Colles fractures" refer to dorsally angulated extra-articular distal radius fractures
  • Epidemiology
    • incidence
      • most common forearm fracture
    • demographics
      • bimodal distribution
        • younger patients
          • high energy injuries
          • more likely to be male
          • account for up to 25% of pediatric fractures
        • elderly patients
          • low energy injuries
          • more likely to be female
          • account for up to 20% of adult fractures
    • risk factors
      • osteoporosis
      • other fragility fractures (vertebral compression fractures and femoral neck fractures) are predictive of subsequent fractures
  • Etiology
    • fall on outstretched hand
  • Pathoanatomy
    • normal anatomy
      • radius and ulna are 2 bones of the forearm
      • radius widens in the distal forearm while the ulna narrows
      • distally, the radius articulates with three bones
        • ulna (distal radioulnar joint)
        • scaphoid (radioscaphoid joint)
        • lunate (radiolunate joint)
    • fracture location
      • most fractures occur at distal radial metaphysis and can be
        • extra-articular or intra-articular
        • dorsally or volarly angulated
        • dorsally or volarly displaced
  • Associated conditions
    • distal radioulnar joint (DRUJ) injury
    • radial styloid fracture
    • ligamentous injuries
      • triangular fibrocartilage complex (TFCC) injury
      • scapholunate ligament injury
  • Prognosis
    • favorable
      • well-aligned anatomic reduction
    • negative
      • associated neurovascular injuries
      • fracture shortening on pre-reduction radiographs
      • osteoporotic bone
      • old age
Presentation
  • Symptoms
    • severe wrist pain
    • pain with motion
  • Physical exam
    • swelling
    • ecchymosis
    • tenderness to palpation
    • limited range of motion
    • deformity corresponding to fracture angulation and displacement
Imaging
  • Radiography
    • indication
      • always indicated if fracture is suspected
    • findings
      • fracture fragment through distal radial metaphysis
      • eponymous fractures
        • Colles fracture
          • dorsally angulated extraarticular distal radius fracture
  • Computerized tomography (CT) scan 
    • indications
      • suspicion of intra-articular fracture
      • highly comminuted fractures
    • findings
      • can better demonstrate intra-articular involvment and multiple fracture fragments
  • Magnetic resonance imaging (MRI) scan 
    • indications
      • suspicion of associated ligamentous injuries
    • findings
      • TFCC tear
      • scapholunate ligament tear
Differential
  • Scaphoid fracture
    • may have snuffbox tenderness without tenderness on distal radius
    • wrist radiographs may be normal
  • DRUJ dislocation
    • wrist radiographs may demonstrate radioulnar widening with no fracture lines
Treatment
  • Nonoperative
    • closed reduction and cast immobilization
      • indication
        • most non-comminuted extra-articular fractures
  • Operative
    • open reduction internal fixation (ORIF)
      • indication
        • unstable fractures
          • displaced intra-articular fractures
          • comminuted fractures
Complications
  • Median nerve neuropathy
    • acute carpal tunnel syndrome
  • Extensor pollicis longus rupture
  • Malunion or nonunion
 

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