Wrist fractures
Dr. Wahby Ghalib CABMS, FJMC, MRCSFractures 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 handColles` #
Transverse ExtraarticularDistal fragment : impacted tilted dorsally tilted radially dinner-fork deformity
Rx
CR + below elbow cast 6w
CxNerve 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 stableDR # 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
XRScaphoid view Motion views : instability
Unstable #Oblique 1mm gap # dislocation Proximal pole Motion views +ve
RxStable castUnstable ORIF
Cast
Glass - holding position 6w then assess healing : if still reapply for 6wNonunion : after 12w ORIFIf clinically suggestive but -ve XR………………
Slab for 2w then XR if still -ve bone scan or MRI if -ve & still pain continue immobilizationCx
AVN Nonunion OA
Lunate & perilunate dislocation
Fall on outstreched hand CF : swelling paraesthesia Can be associated with scaphoid # Rx : CR + slab