![]() ![]() Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults. Management of Distal Radius Fractures Evidence-Based Clinical Practice Guideline. Radiologic Evaluation of the Distal Radius Indices in Early And Late Childhood. ![]() Hosseinzadeh P, Olson D, Eads R, Jaglowicz A, Goldfarb CA, Riley SA. Is it really necessary to restore radial anatomic parameters after distal radius fractures?. Perugia D, Guzzini M, Civitenga C, et al. Distal Radius Fractures-Classification of Treatment and Indications for Surgery. New classification of lunate fossa fractures of the distal radius. Zhang J, Ji X ran, Peng Y, Li J tao, Zhang L hai, Tang P fu. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Evidence-Based Review of Distal Radius Fractures. The Epidemiology of Distal Radius Fractures. External fixation: typically used in patients with severe soft tissue injury and/or polytrauma.K-wire fixation: typically limited to patients with minimal fracture comminution and healthy bone.Open reduction internal fixation: Fixed-angle volar plates are used for displaced, unstable, and/or involve osteoporotic bone.Any of the following post-reduction radiographic signs of instability:Īll procedures require postoperative immobilization of the forearm and wrist.Open, significantly displaced, intraarticular, and/or unstable fractures.Operative fixation in patients ≥ 65 years of age does not improve long-term functional outcomes. The radius should be realigned to its normal position after fracture reduction. See also “ Conservative management of fractures.”.Postreduction x-rays and serial exams to evaluate for subsequent displacement.Initial immobilization in sugar tong splint.Closed reduction while applying longitudinal traction through the fingers either manually or using a finger trap.Nondisplaced and stable fractures are typically managed with closed reduction and immobilization. > 20° dorsal (Colles) or volar (Smith) angulation.Indications for an emergent orthopedic consult Initial management of distal radius fractures by fracture type Obtain a second set of x-rays after reduction and immobilization of the fracture. CT wrist: may be required for preoperative planning.See “ Radiographic signs of a fracture.”.A line along the dorsal to palmar articular surface of radius.On lateral view, measure the angle between:.Volar inclination: Inclination > 20° indicates a potentially unstable fracture.A line across the articular surface perpendicular to the long axis of the radius.A line from the radial styloid to the ulnar border of distal radius.On posterior- anterior view, measure the angle between:.Radial inclination: Inclination ≥ 10–15° indicates acceptable fracture reduction.Assess angulation, rotational deformity, shortening, joint alignment, and comminution.X-ray : anterior- posterior, lateral, and oblique views of the wrist (including the carpal bones).Repeat the neurovascular exam after reduction and again after immobilization of the radial fracture. Skin exam: Evaluate for laceration, tearing, and tenting.Repeat the exam after reduction and again after immobilization.Evaluate for median nerve injury, radial nerve injury, and ulnar nerve injury. ![]() Assess radial and ulnar artery pulses and capillary refill time.Intraarticular depression fracture of the lunate fossa of the distal radius.Result of an axial or transverse load through the lunate into the radius.The radial styloid is intraarticularly avulsed.Result of a direct blow to the radial portion of the wrist.Hutchinson fracture ( Chauffeur fracture ).The radiocarpal segment is avulsed and volarly displaced.An intraarticular fracture and dislocation.The radiocarpal segment is avulsed and dorsally displaced.Intraarticular fracture and dislocation.Intraarticular extension, neurovascular compromise, and/or instability are more likely than in Colles fractures.The distal fragment is volarly angulated and volarly displaced.Result of a fall onto a flexed wrist or direct injury to the back of the wrist. ![]()
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