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Wrist fractures

Dr. Wahby Ghalib
CABMS, FJMC, MRCS

Fractures of distal radius

Colles` #Smith`s #Barton`s #Radial styloid #Die – punch #Distal radius # in childrenComminuted intraarticular #

Colles` #

Very common

Occurs in elderly osteoporotic

Due to fall on outstrethed hand

Colles` #

Transverse ExtraarticularDistal fragment : impacted tilted dorsally tilted radially  dinner-fork deformity


Rx

CR + below elbow cast 6w

Cx

Nerve injury : median

Redisplacement

RSD

Tendon rupture

Smith`s #

Fall on flexed wrist

Garden-spade deformity

Rx

Barton`s #

Oblique split in volar lip of DR distal fragment displaced volar with the carpusRx : unstable #  ORIF

Dorsal Barton`s #

More stable

DR # in children

Physeal #

Salter – Harris I or IICalled juvenile Colles` #

Metaphyseal #

Buckle #

Green stick : liable for redisplacement

Complete

Comminuted intraarticular #

Needs perfect reduction

Radial styloid #

= chauffeur #

Rx : CR + cast
ORIF

Die-punch #

Die-Punch (Lunate Load) Fracture is an intraarticular depression fracture of the lunate fossa of the distal radius

Frykman classification

Scaphoid #

Why important ?

Commonest carpal #Commonly missedCan  complications

Why vulnerable ?

Part of proximal & distal rowsConduit of stresses thru wristBound to strong ligaments  limited motion

Rare in children & elderly

Fall on outstreched hand

Usual site : waist


CF

Full snuff box

Tender snuff box

Painful dorsiflexion

Painful gripping


XR

Scaphoid view

Motion views : instability

Unstable #

Oblique

1mm gap

# dislocation

Proximal pole

Motion views +ve


Rx

Stable  castUnstable  ORIF

Cast


Glass - holding position 6w then assess healing : if still  reapply for 6wNonunion : after 12w  ORIF

If clinically suggestive but -ve XR………………

Slab for 2w then XR  if still -ve  bone scan or MRI  if -ve & still pain continue immobilization


Cx


AVN

Nonunion

OA

Lunate & perilunate dislocation

Fall on outstreched hand

CF : swelling paraesthesia

Can be associated with scaphoid #

Rx : CR + slab




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