FRACTURE OF DISTAL RADIUS

NUR HANISAH BINTI ZAINOREN

ANATOMY

TYPES

1. COLLES’ FRACTURE2. SMITH’S FRACTURE3. BARTON’S FRACTURE

COLLES’ FRACTURE

• Fracture at the distal end of the radius, at its cortico-cancellous junction, with dorsal tilt and other displacements, in an osteoporotic bone

Other displacements (1/> displacements below occur in majority of the cases; although in few cases it may be crack fracture without displacement)

o Impaction of fragmentsoDorsal displacementoDorsal tilto Lateral displacemento Lateral tilto Supination

Injuries associated with Colles’ fracture:

o Fracture of the styloid process of the ulnaoRupture of the ulnar collateral ligamentoRupture of the triangular cartilage of the ulnaoRupture of the interosseous radio-ulnar ligament,

causing radioulnar subluxation

Clinical features:

oPaino SwellingoDeformity of the wristoOn examination;

Tenderness Irregularity of the lower

end of radius

Radiological features: (Differentiated from other fractures at the same site by looking at the displacements)

oDorsal tilt can be detected on a lateral X-ray:

normal faces ventrally dorsal tilt faces dorsally or

becomes neutral

o Lateral tilt can be detected on an AP X-ray:

normal faces medially lateral tilt faces laterally or

becomes horizontal

Treatment:

oUndisplaced fracture immobilization in a below-elbow plaster cast for 6 weeks

oDisplaced fracture manipulative reduction followed by immobilization in Colles’ cast

Complications:1. Stiffness of joints2. Malunion3. Subluxation of the inferior radio-ulnar joint4. Carpal tunnel syndrome5. Sudeck’s osteodystrophy6. Rupture of the extensor pollicis longus tendon

SMITH’S FRACTURE

• Fracture at the distal end of the radius, at its cortico-cancellous junction, with ventral tilt and other displacements

• Uncommon

• Treatment:• Closed reduction • Plaster cast immobilization (6

weeks)

BARTON’S FRACTURE

• Intra-articular fracture of the distal radius

• Extends from the articular surface of the radius to either its anterior/posterior cortices

• The small distal fragments gets displaced and carries with it, the carpals

• Displacements:• Volar Barton’s fracture

(anterior type)• Dorsal Barton’s fracture

(posterior type)

• Treatment:• Closed manipulation • ORIF with plate in cases

where closed reduction fails

REFERENCE

• Essential Orthopaedics, 4th Edition, Maheshwari & Mhaskar, JAYPEE

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