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1

L2 Orthope dic D. Wahby Ghalib

W rist 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 Extraartic ular
o Distal fragment : impacted
 tilted dorsally
 tilted radially
o dinner -fork defor mity

2

Rx
o CR + belo w elbow cast 6w
Cx
o Ner ve 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 sp lit in volar lip of DR
 distal fragment displaced volar
with the carpus
o Rx : unstable #  ORIF

Dorsal Barton`s #

 More stable

DR # in chi ldren

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 = ch auffeur #
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
 Condu it 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


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