Transcript Document

FRACTURE OF THE
DISTAL RADIUS
Speaker: R1 蔡尚霖
Supervisor: VS 張志偉
Overview
 The most common fractures of the upper
extremities (17%)
 60-70 y/o, Female
 Residual articular incongruity leads to posttraumatic arthritis in most patients
Mechanism of injury
 90%: compressive loading on the dorsiflexed
wrist
 The degree of comminution is proportional to
the energy transferred to the bone
Anatomy
 Bony anatomy
 Ligamentous anatomy
 Radiographic measurements
 DRUJ
Triangular fibrocartilage complex
Volar extrinsic lig.
Radial inclination
Radial length
Volar tilt
Classification of fractures
[1/2]
 Common eponyms
 Colles’ fracture
 Smith’s fracture
 Barton’s fracture
 Chauffeur’s fracture
 Die-Punch fracture
Common eponyms
Die-punch (lunate
load)
Classification of fractures
[2/2]
 Modern classification systems
 Frykman classification
 Melone’s classification
 AO/ASIF classification
 Rayhack’s classification
 Fernandez’s classification
 Universal classification
Frykman classification
AO classification
[1/3]
AO classification
[2/3]
AO classification
[3/3]
Melone’s classification
1. Radial shaft
2. Radial styloid
3. Palmar medial fragment
4. Dorsal medial fragment
Evaluation
 Plain radiography
 PA and lateral views
 Oblique views - occult carpal fracture (12%)
 PA ulnar-deviation view - scaphoid
 Special studies
 CT – die-punch frx
 MRI – soft tissue, TFCC…
 Radionuclide bone imaging – occult frx, RSD
Associated soft tissue
injuries
 Open fracture
 Median nerve injury
 TFCC injury – ulnar styloid frx, 50%
 Carpal ligament injury
 Tendon injury
 Arterial injury
 Compartment syndrome – 1%
Treatment
 Principles
 Assessment of stability
 Articular depression > 2mm
 Radial shortening > 5mm
 Dorsal tilt > 20 degree
 Barton’s, Chauffeur’s fracture
 Assessment of reduction
Treatment
 Methods of reduction
 Close reduction
 Open reduction
 Limited dorsal approach
 Formal dorsal approach
 Standard volar approach
 Extensive volar approach
 Dorsal radial approach
 Combined volar and dorsal approach
 Bone graft
Treatment
 Methods of stabilization
 Plaster cast or splint
 Pins and plaster
 Percutaneous Pin fixation
 External fixation
 ORIF
 Arthroscopic evaluation & treatment
Late complications
 Malunion
 Extra-articular: dorsal tilt, radial length
 Intra-articular: early onset of arthritis
 Nonunion
 Tendon problems (extensor pollicis longus t.)
 Adhesion
 Tendinitis
 Rupture
 RSD (2-20%)
Thanks for your attention~