Updated: 12/27/2021

Distal Radius Fracture

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  • Snapshot
    • A 72-year-old woman trips and falls on her outstretched right hand. She experiences immediate pain and swelling over her right wrist. On exam, she has a dinner-fork deformity of the wrist and exquisite pain with passive motion. A radiograph is shown, which reveals a dorsally angulated distal radius fracture.
  • Introduction
    • Clinical definition
      • forearm fracture of the distal end of the radius
        • considered 1 of 3 common "fragility fractures" associated with osteoporosis
          • other 2 are vertebral compression fractures and femoral neck fractures
        • "Colles fractures" refer to dorsally angulated extra-articular distal radius fractures
  • Epidemiology
    • Incidence
      • most common forearm fracture
    • Demographics
      • bimodal distribution
        • younger patients
          • high energy injuries
          • more likely to be male
          • account for up to 25% of pediatric fractures
        • elderly patients
          • low energy injuries
          • more likely to be female
          • account for up to 20% of adult fractures
    • Risk factors
      • osteoporosis
      • other fragility fractures (vertebral compression fractures and femoral neck fractures) are predictive of subsequent fractures
  • Etiology
    • Fall on outstretched hand
    • Pathoanatomy
      • normal anatomy
        • radius and ulna are two bones of the forearm
        • radius widens in the distal forearm while the ulna narrows
        • distally, the radius articulates with 3 bones
          • ulna (distal radioulnar joint)
          • scaphoid (radioscaphoid joint)
          • lunate (radiolunate joint)
      • fracture location
        • most fractures occur at distal radial metaphysis can be
          • extra-articular or intra-articular
          • dorsally or volarly angulated
          • dorsally or volarly displaced
    • Associated conditions
      • distal radioulnar joint (DRUJ) injury
      • radial styloid fracture
      • ligamentous injuries
        • triangular fibrocartilage complex (TFCC) injury
        • scapholunate ligament injury
  • Presentation
    • Symptoms
      • severe wrist pain
        • worse with passive motion
    • Physical exam
      • swelling
      • ecchymosis
      • tenderness to palpation
      • limited range of motion
      • deformity corresponding to fracture angulation and displacement
      • compartment syndrome should be carefully ruled out in forearm fractures
  • Imaging
    • Radiography
      • indications
        • always indicated if fracture is suspected
      • findings
        • fracture fragment through distal radial metaphysis
        • eponymous fractures
          • Colles fracture
            • dorsally angulated extraarticular distal radius fracture
          • Smith fracture
            • volarly angulated extraarticular distal radius fracture
          • Barton fracture
            • intra-articular fracture involving volar or dorsal lip of distal radius with an associated fracture dislocation of the radiocarpal joint
    • Computerized tomography (CT) scan
      • indications
        • suspicion for intra-articular fracture
        • highly comminuted fractures to better discern fracture pattern
      • findings
        • can better demonstrate extent of intra-articular involvement and individual fracture fragments
    • Magnetic resonance imaging (MRI) scan
      • indication
        • suspicion for associated ligamentous injuries
      • findings
        • TFCC tear
        • scapholunate ligament tear
  • Differential
    • Scaphoid fracture
      • tenderness will be localized to the thenar snuffbox more than the distal radius
      • radiographs will be normal or show a fracture line in the scaphoid
    • DRUJ dislocation
      • radiographs will demonstrate radioulnar instability
  • Treatment
    • Nonoperative
      • closed reduction followed by immobilization
        • indication
          • most non-comminuted extra-articular distal radius fractures
    • Operative
      • open reduction and internal fixation
        • indications
          • unstable fractures
            • intra-articular fractures
            • severely displaced fractures post-reduction
            • comminuted fractures
  • Complications
    • Median nerve neuropathy
      • acute carpal tunnel syndrome
    • Extensor pollicis longus rupture
    • Malunion or nonunion
  • Prognosis
    • Favorable
      • well-aligned anatomic reduction
    • Negative
      • associated neurovascular injuries
      • fracture shortening on pre-reduction radiographs
      • osteoporotic bone
      • old age
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