1
L2 Orthopedic D. Wahby Ghalib
Wrist Fractures
Fractures of distal radius
o Colles` #
o Smith`s #
o Barton`s #
o Radial styloid #
o Die – punch #
o Distal radius # in children
o Comminuted intraarticular #
Colles` #
o Very common
o Occurs in elderly osteoporotic
o Due to fall on outstrethed hand
o Transverse
o Extraarticular
o Distal fragment : impacted
tilted dorsally
tilted radially
o dinner-fork deformity
2
Rx
o CR + below elbow cast 6w
Cx
o Nerve injury : median
o Redisplacement
o RSD
o Tendon rupture
Smith`s #
o Fall on flexed
wrist
o Garden-spade
deformity
o Rx
3
Barton`s #
o Oblique split in volar lip of DR
distal fragment displaced volar
with the carpus
o Rx : unstable #
ORIF
Dorsal Barton`s #
More stable
DR # in children
Physeal #
o Salter – Harris I or II
o Called juvenile Colles` #
Metaphyseal #
o Buckle #
o Green stick : liable for redisplacement
o Complete
4
5
Comminuted intraarticular #
o Needs perfect reduction
Radial styloid #
o = chauffeur #
o Rx : CR + cast
o ORIF
Die-punch #
Die-Punch
(Lunate
Load)
Fracture
is
an
intraarticular depression fracture of the lunate fossa
of the distal radius
Frykman classification
o 1-2 Extra-articular # ± distal ulna #
o 3-4 intra-articular # involving the radiocarpal
joint ± distal ulna #
o 5-6 Intra-articular # involving the DRUJ ± distal
ulna #
o 7-8 Intra-articular # involving the RC and DRUJ
± distal ulna #
6
Scaphoid #
Why important ?
o Commonest carpal #
o Commonly missed
o Can
complications
Why vulnerable ?
Part of proximal & distal rows
Conduit of stresses thru wrist
Bound 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
7
XR
Scaphoid view
Motion views : instability
Unstable #
Oblique
1mm gap
# dislocation
Proximal pole
Motion views +ve
Rx
Stable
cast
Unstable
ORIF
Cast
Glass - holding position
6w then assess healing : if still
reapply
for 6w
Nonunion : after 12w
ORIF
8
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
9
Lunate & perilunate dislocation
Fall on outstreched hand
CF : swelling paraesthesia
Can be associated with scaphoid #
Rx : CR + slab
Mubark A. Wilkins