Distal Radius Fractures in Orthopedics

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Questions and Answers

What is the most common cause of distal radius fractures in younger patients?

Low energy falls

High energy trauma (correct)

Chronic overuse

Osteoporosis

Which fracture is characterized as being dorsally displaced and associated with low energy?

Ulnar fracture

Frykman fracture

Colles fracture (correct)

Smith fracture

What imaging technique is particularly important for evaluating intra-articular involvement and surgical planning in wrist injuries?

MRI

X-ray

Ultrasound

CT (correct)

What is recommended for women with a distal radius fracture due to its association with future fractures?

Bone density testing (DEXA scan) Signup and view all the answers

Which Frykman classification involves both radiocarpal and distal radioulnar joint involvement?

Type VII Signup and view all the answers

What is a common neurological complication following a distal radius fracture?

Medial nerve neuropathy (CTS) Signup and view all the answers

Which operative treatment indication requires surgical fixation of distal radius fractures?

Severe osteoporosis Signup and view all the answers

Which type of fracture is characterized as a volar displaced extraarticular fracture?

Smith fracture Signup and view all the answers

What type of closed reduction is recommended for non-displaced fractures and some stable conditions?

Cast immobilization Signup and view all the answers

What is the standard nonoperative treatment for stable nondisplaced scaphoid fractures?

Thumb spica cast immobilization Signup and view all the answers

Which of the following treatments is typically combined with external fixation for unstable wrist joints?

Percutaneous pinning Signup and view all the answers

Which of the following fractures are indications for open reduction and internal fixation (ORIF)?

Fractures with displacement greater than 1 mm Signup and view all the answers

What is the potential complication of a proximal pole fracture of the scaphoid?

Nonunion Signup and view all the answers

How do the flexor digitorum profundus and flexor digitorum superficialis differ in function?

FDP flexes the DIP joint, FDS flexes the PIP joint Signup and view all the answers

What is a common symptom indicative of tendon injury in the fingers?

Loss of active flexion strength or motion Signup and view all the answers

Which of the following is not a feature of scaphoid fractures that require operative treatment?

Non-displaced waist fractures Signup and view all the answers

What is the primary wrist flexor that inserts on the base of the 2nd metacarpal?

Flexor carpi radialis Signup and view all the answers

Which imaging technique is more effective than CT for diagnosing occult fractures?

Bone scan Signup and view all the answers

What outcome is expected with operative treatment of scaphoid fractures?

Union rates of 90-95% Signup and view all the answers

Which angle indicates the need for surgery if it is greater than 15°?

Radiolunate angle Signup and view all the answers

What does maintenance of extension at the PIP or DIP joints with wrist extension indicate?

Flexor tendon discontinuity Signup and view all the answers

What is the ideal timing for flexor tendon repair following an injury?

Within 2 weeks Signup and view all the answers

What is the primary reason for improved results with postoperative tendon repair in zone II?

Postoperative controlled mobilization Signup and view all the answers

Which protocol includes dynamic splint-assisted passive finger flexion?

Kleinert protocol Signup and view all the answers

What is the most common complication following tendon repair?

Tendon adhesions Signup and view all the answers

What is recommended for immobilizing children and noncompliant patients after repair?

Casts or splints in specific joint positions Signup and view all the answers

What is the primary focus of early active motion protocols in rehabilitation?

Moderate force and potentially high excursion Signup and view all the answers

What is a possible outcome of untreated flexor tendon injuries?

Tendon retraction and gap formation Signup and view all the answers

What is indicated by lacerations greater than 60% of tendon width?

Flexor tendon reconstruction Signup and view all the answers

What should be done if 1cm of scar is present after rerupture?

Perform tendon graft Signup and view all the answers

What is the primary method of blood supply to the scaphoid?

Dorsal carpal branch of the radial artery Signup and view all the answers

Which of the following is NOT a common treatment for progressive carpal tunnel syndrome?

Immobilization of the wrist Signup and view all the answers

What percentage of wrist injuries are accounted for by scaphoid fractures?

15% Signup and view all the answers

What finding is commonly assessed as part of the scaphoid fracture diagnosis?

Swelling and tenderness in the anatomical snuffbox Signup and view all the answers

Which imaging technique is the most sensitive for diagnosing occult fractures of the scaphoid?

MRI Signup and view all the answers

What is a common complication associated with distal radius ulnar joint injuries?

Ulnar nerve neuropathy Signup and view all the answers

Which factor significantly contributes to the development of symptomatic radiocarpal arthrosis?

Articular step-off greater than 1-2 mm Signup and view all the answers

In the context of scaphoid fractures, how is a positive scaphoid compression test defined?

Pain reproduced with axial load applied through the thumb metacarpal Signup and view all the answers

What is the typical incidence of scaphoid fractures in all carpal fractures?

60% Signup and view all the answers

Which of the following is a common cause of scaphoid fractures?

Axial load across hyper-extended radially deviated wrist Signup and view all the answers

Study Notes

Wrist & Hand Injuries

Wrist and hand injuries are a common orthopaedic concern.
Distal radial fractures are a frequent injury.
Distal radial fractures have a bimodal distribution. Younger patients may experience high-energy trauma, while older individuals may be affected by low-energy falls.
Distal radius fractures are more prevalent in women over 50.
Distal radius fractures can predict future fractures.
A DEXA scan is advised for women with a distal radius fracture.

Frykman Classification

This system categorizes distal radius fractures based on ulnar fracture presence and intra-articular involvement.
Fracture types are numbered (I-VIII).
- Extraarticular fracture types are numbered I and II
- Intraarticular fractures involving the radiocarpal joint are numbered III and IV.
- Intraarticular fractures involving the distal radioulnar joint are numbered V and VI.
- Intraarticular fractures involving both the radiocarpal and distal radioulnar joints are numbered VII and VIII.

Types of Fractures

Colles fracture: Low-energy injury, dorsally displaced, extraarticular fracture.
Smith fracture: Low-energy fracture, volarly displaced, extraarticular fracture.

Diagnosis

History of trauma.
Patient pain.
Swelling and deformity present.

Imaging

X-rays are a fundamental diagnostic tool.
CT scans are pivotal for evaluating intra-articular involvement and surgical planning.
MRI scans are useful for assessing soft tissues, especially in cases of distal radioulnar joint (DRUJ) or scapholunate ligament injuries.

Nonoperative Treatment

Closed reduction with a cast immobilization is suitable for extraarticular and minimally displaced fractures.
Physical therapy provides no significant benefit over home exercises for simple fractures treated with cast immobilization.

Operative Treatment

Surgical fixation (CRPP, external fixation, or ORIF).
Indications for surgical intervention include:
- Radiographic findings of instability.
- Displaced intraarticular fractures.
- Vola or dorsal comminution.
- Severe osteoporosis.
- Progressive loss of volar tilt or radial length after conservative treatment.
- Associated ulnar styloid fracture.
Percutaneous pinning is a technique used for mild angulation in extraarticular fractures.
External fixation is often combined with percutaneous pinning or plate fixation for unstable wrist joints.
Open reduction and internal fixation (ORIF) is recommended for fractures with significant articular displacement (greater than 2mm), comminution, and associated distal ulnar shaft fractures.

Complications

Median nerve neuropathy (carpal tunnel syndrome, CTS) from immobilization, especially common with high-energy trauma, is a key complication.
- Prevention of prolonged wrist flexion and ulnar deviation is important.
- Acute carpal tunnel release is a potential treatment for progressive symptoms.
Ulnar nerve neuropathy is possible in DRUJ injuries.
EPL rupture is a potential complication in nondisplaced fractures.
Radiocarpal arthrosis frequently develops in young adults if articular step-off exceeds 1-2 mm.
Malunion and nonunion of the wrist are potential problems.
Compartment syndrome is possible.

Scaphoid Fractures

Scaphoid fractures account for 15% of acute wrist injuries and 60% of all carpal fractures.
The waist of the scaphoid makes up 65% of these types of breaks. Proximal third comprises 25% and distal third accounts for 10%.

Anatomy

The wrist comprises two rows of bones important for motion and force transfer.
Specific bones of the wrist include capitate, hamate, lunate, scaphoid, triquetrum, pisiform, trapezoid, and trapezium.

Pathoanatomy

Axial loading forces across a hyper-extended and radially deviated wrist are the primary cause of many injuries.
These injuries are commonly found in contact sports.

Blood Supply

The primary blood supply to the proximal 80% of the scaphoid is from the dorsal carpal branch of the radial artery.
The distal 20% is supplied by the superficial palmar arch (branch of volar radial artery).

Mayo Classification

This method classifies scaphoid fractures based on the location of fracture (distal third, middle third, and proximal third).

Russe Classification

The Russe Classification system categorizes scaphoid fractures based on their fracture lines which vary in direction (horizontal oblique, transverse, or vertical oblique).

Provocative Tests

Anatomic snuffbox tenderness, scaphoid tubercle tenderness (volarly), and scaphoid compression test are indicators for scaphoid fracture, with high specificity and sensitivity.

Diagnosis (cont'd)

History of the injury, physical exam, and relevant imaging are crucial for diagnosis.
History can include trauma, pain, swelling, deformity. Exam might include wrist swelling, ecchymosis, hematoma, gross deformity, pain with resisted pronation.
Provocative tests should aid in confirming diagnosis and identifying the fracture or problems with the related tissues.
Important tests include a normal range of motion (active and passive), and neurovascular tests.

Imaging (continued)

Radiographs for scaphoid fractures should include AP and lateral views, and a scaphoid view at 30° wrist extension and 20° ulnar deviation.
If radiographs are negative but a high clinical suspicion for a scaphoid fracture exists, a repeat x-ray should be performed in 14-21 days.
MRI and bone scans can be necessary if the x-ray is unsuccessful in identifying the fracture

Treatment (continued)

Nonoperative treatment is typically done with a thumb spica cast. Indications include stable, nondisplaced fractures. Outcomes depend on the fracture's characteristics. If stable and nondisplaced, 90% of patients have a union rate.
Operative treatment is used for unstable fractures.
- Indications include displaced intra-articular fractures.
- Fracture fixation may include percutaneous screw fixation, or open reduction and internal fixation (ORIF), or external fixation.
Outcomes for surgical treatment are higher but vary depending on the procedures done and the characteristics of the fracture.

Complications (continued)

Complications following treatment can include nonunion (5-15%) and malunion (humpback deformity).
Avascular necrosis of the proximal pole may occur.
Wrist osteoarthritis and chronic regional pain syndrome are potential consequences.

Flexor Tendon Injuries

Injuries to flexor tendons are a critical consideration in wrist and hand injuries.
Key tendons in the hand include FDP, FDS, and FPL.
Key tendons in the wrist include FCR and FCU.
An important concept about tendon injuries is the Zones of Injury.
- Proper diagnosis, treatment, and rehabilitation protocols are important for successful outcomes.

Treatment and Rehabilitation

Treatment and rehabilitation are important concepts for these injuries and require specialized understanding of the anatomy and clinical assessment aspects of the injuries.
Nonoperative treatment for partial lacerations may be enough, with early range of motion.
Operative treatment is indicated for lacerations exceeding 60% tendon width.
- Timing of operation is very critical, with ideal repair within 2-3 weeks.
- Post-operative rehabilitation includes mobilization.
- Potential complications include tendon adhesions.

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Description

Test your knowledge on distal radius fractures with this quiz that covers common causes, classifications, imaging techniques, and treatment recommendations. Dive into the details of evaluation and management strategies for wrist injuries, including surgical interventions and complications.