The treatment of distal radius fractures summary of recommendations the following is a summary of the recommendations in the aaos clinical practice guideline, the treatment of distal radius fractures. Having a distal radius fracture can be the first sign that bones are weakened by osteoporosis1. Fishman, in kelley and firesteins textbook of rheumatology tenth edition, 2017. Background the radius is the most common bone in the arm to sustain a fracture. Recovering from a distal radius fracture sportshealth.
An improved understanding of kinematics, bone quality, and muscle forces acting across the fracture has led to increased awareness. This fracture was first described in 1814 by an irish surgeon and anatomist. Guideline treatment of distal radius fractures in adults. In 1814, abraham colles published the first narrative of distal radius fractures in which the injury was described as a dorsally angulated fracture that healed with perfect freedom of motion.
Involvement of the druj in distal radius fractures is similarly underestimated on radiographs compared with ct. Jul 20, 2010 distal radius fractures are among the most common fractures in the body, usually occurring as a result of a fall. Justin mirza of mirza orthopedics outline the different types of distal radius fractures and explain how the type of fracture affects the treatment needed. Complications of distal radius fracture fixation may arise from the injury or method of treatment, as well as both. Incidence rates indicate more than 15 000 of these fractures each year in norway 1, 2.
Distal radius fractures orthopaedic trauma association. Specific qualitative and quantitative features of the distal radius fracture apparent on the radiograph are discussed. Client centered approach to distal radius fracture management. Aug 06, 2018 the extended flexor carpi radialis approach. Atlas of distal radius fracturesoriginal pdf all ebook. Aspects of current management of distal radius fractures. The wrist and arm should be functional for most activity by 8 to 10 weeks after surgery.
Although sometimes stated otherwise, the outcome of these fractures is not uniformly good regardless the treatment instituted. Patients with a distal radius fracture generally present with a history of recent trauma with subsequent pain, swelling, ecchymosis, and often an obvious deformity of. Classification of distal radius fractures wikipedia. Foldhazy z, tornkvist h, elmstedt e, andersson g, hagsten b, ahrengart l. Pragmatic and reader friendly, distal radius fractures. Occasionally you may also have a small chip fracture at the top of your ulna, which is the other wrist bone that sits below the line of your little finger. Your hand therapist will send you for an xray of your wrist. Orif of intraarticular distal radius fracture with druj instability 26. Distal radius fractures are commonly associated with ulnar fractures, either at the same level or at the ulnar styloid. We conclude with a series of questions the radiologist should address in the initial description of fracture involving the distal radius. Distal radius fractures state of the art disclosure skeletal dynamics.
Distal radius fracture orif rehabilitation protocol kelly holtkamp, m. Symptoms include pain, bruising, and rapidonset swelling. Effective restoration of the bony architecture requires intimate knowledge of the anatomy of the distal radius, a thorough understanding of the goals of treatment, versatility in surgical approaches, and familiarity with. Distal radius fractures often occur as a result of a fall on an outstretched hand. Most of the fractures are caused by a fall on the outstretched hand with the wrist in dorsiflexion. Distal radial fractures can be seen in any group of patients and there is a bimodal age and sex. Defining residual radial translation of distal radius. Wolfe with the wide array of treatment options now available, this is an exciting era for the treatment of fractures of the distal radius. Diatal radius fractures drfs are typical fractures of relatively fit persons with osteoporotic bone. These may or may not require surgery depending on the degree of displacement or comminution. A distal radius fracture is a very common injury that can occur because of a simple fall in some cases. The dorsal or palmar tilt is the angle created with a line drawn along the longitudinal axis of the radius radial length radial length is measured on the pa radiograph. Factors predicting late collapse of distal radius fractures. Traditionally, drfs in older patients have been treated with closed reduction and cast immobilization.
Ring d, jupiter jb, brenn the incidence of tendon rupture in nonoperative management of distal radius fractures has been reported to be as high as 3%, with extensor pollicis longus. Feb 19, 2019 distal radius fractures account for approximately 15% of all fractures in adults. Abraham colles is credited with description of the most common fracture pattern affecting distal end radius in 1814, and is classically named after him. Each chapter offers a comprehensive guide to the diagnosis and treatment of a specific fracture, including possible complications. The break can occur in many different ways, however. May a 16 have shown that 11% to 19% of patients with distal radius fractures suffered from problems of the druj following these injuries. Warhold describes the treatment options for this common type of break. The injury mechanism is normally a fall onto an outstretched hand. Atlas of distal radius fractures pdf by francisco del pinal author written by one of the worlds foremost authorities, this beautifully illustrated surgical atlas is a casebased presentation of the management of distal radius fractures.
A transverse, extraarticular fracture of the distal radius distal 2cm of the radius that is angulated dorsally and impacted by the proximal carpal row the scaphoid and. One must assess the joints above and below to rule out a concomitant injury. Dorsalpalmar tilt on a true lateral view a line is drawn connecting the most distal points of the volar and dorsal lips of the radius. Written by one of the worlds foremost authorities, this beautifully illustrated surgical atlas is a casebased presentation of the management of distal radius fractures. Colles fracture specifically is defined as metaphyseal. The frykman classification of distal radial fractures is based on the ap appearance and encompasses the eponymous entities of colles fracture, smith fracture, barton fracture, chauffeur fracture.
A distal radius fracture occurs when a sudden force causes the radius bone, located on the thumb side of the wrist, to break. A displaced fracture will typically result in a wrist deformity. Distal radial fractures are a heterogeneous group of fractures that occur at the distal radius and are the dominant fracture type at the wrist. Lecture given at apta 2004 combined sections meeting. Evans, otrl, cht march 8, 2015 drf is the most common fx in human skeleton, comprising 18% of all fractures and affecting an estimated 85,000 medicare beneficiaries each year. Price is surgeon in chief, nemours childrens clinic, orlando, fla. Plus, learn about advancements in using the platingscrew approach, which allows you to immediately use your hand. Distal radius fracture an overview sciencedirect topics. Distal radius fractures common injury fractures of the distal radius represent approximately 16% of all fractures treated by orthopaedic surgeons three main peaks of fracture distribution. Modality of treatment for the distal end radius fracture. Although frequently encountered by the radiologist, those attributes that should be highlighted to guide treatment options may not be emphasized in the radiologists report. The most common cause of distal radius fracture is a fall onto an outstretched hand, from either slipping or. An open fracture means a bone fragment has broken through the skin.
The injuries occur when the wrist is subject to nonphysiologic loads, such as falling on an outstretched hand. Your splintdressing should remain on until your first postoperative visit which will be 814 days after surgery and will be on your discharge paperwork. Distal radius fractures are a common injury, particularly in the elderly population. Distal radius fractures are the most frequently occurring type of fracture in norway, accounting for about 20 % of all fractures. Associated injuries may accompany distal radius fractures. Distal radius fractures sunshine coast hand therapy. This study concludes that incidence of distal end radius fracture plating had increased over a. Evidence based postoperative treatment of distal radius.
Benefits nonjoint spanning exfix rigid anatomic fixation early motion. Distal radial fractures are one of the most common fractures of the upper extremity. Atlas of distal radius fractures free pdf download. The mechanism of injury may be due to lowenergy falls, especially in women with osteoporosis, or highenergy trauma that occurs during sports or motor vehicle accidents. Distal radius fractures are among the most common bone injuries, comprising of one of every six fractures seen in emergency rooms. Longterm outcome of nonsurgically treated distal radius fractures. Longterm outcomes were equivalent, despite more loss of reduction in the. Hand therapy the aim of treatment is to get the broken bone into a good position and keep it there while your body heals it. Treatment of distal radius fractures in adults norwegian orthopaedic association the norwegian medical association 6 of 111 if you choose to treat an unstable distal radius fracture in adult patients with percutaneous pinning, we. What are the different types of distal radius fractures. Distal radius fractures, do they all need to be fixed.
The overall complication rate of distal radius fractures ranges from 6% to 80% and has been associated with poor functional outcomes. The work group deemed that it is warranted to issue a recommendation on this topic despite a lack of evidence determining maintenance of adequate fracture reduction during nonoperative treatment. The distal radius is the most common fracture site in the upper extremity. After a surgical procedure such as external fixation or internal plate fixation, a cast will not be necessary. Distal radius fracture washington university orthopedics. A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Torus fractures and minimally displaced fracture is treated by removable splints instead of circumferential casts with improved secondary outcomes for the patient and family and with equal position at healing. Therapist management of distal radius fracture october 18, 2019 cindy quinnelly, ms, otrl, cht 1. The fracture group included those recovering from distal radius fracture managed with open reduction and internal fixation using a volar plate. Pediatric distal radius fractures and complications round out the presentation. W1 role of advanced imaging in distal radius fractures. A nonspanning fixator is one which fixes distal radius fracture by securing pins in the radius alone, proximal to and distal to the fracture site. Forearm and distal radius fractures in children kenneth i noonan, md, and charles t price, md dr.
There are a number of ways to classify distal radius fractures. After about 3 to 6 months, most patients can resume heavier wrist or arm activity and sports. A clinical casebook will be an excellent resource for orthopedic surgeons, hand and upper extremity surgeons and sports medicine specialists confronted with both common and complex fractures to the distal. In younger people, these fractures typically occur during sports or a motor vehicle collision. The radius is the most commonly broken bone in the arm. There is a risk of infection with an open fracture. Such injuries account for approximately onesixth of fractures treated in united states emergency departments eds 1. Ligamentous structures around the druj are strong stabilizers of the wrist joint, so any disruption of this mechanism may lead to instability. The form and severity of fracture of distal radius as well as the concomitant injury of discoligamentary structures of the wrist also depend on the position of the wrist at the moment of hitting the ground. Ppt distal radius fractures powerpoint presentation free.
Distal radius fracture orif rehabilitation protocol. Frykman classification of distal radial fractures radiology. This is located at the bottom of your forearm, just below your thumb joint. It is a distal metaphyseal fracture of distal radius, which occurs within 2 cm of the articular surface and may extend into the distal radiocarpal or radioulnar joints. A thorough understanding of the pathophysiology and treatment of distal radius fractures is important because these injuries are not limited to just the elderly population. The most commonly broken bone in the wrist is the radius bone. Distal radius fractures are common and comprise 15% of extremity fractures. Intraarticular incongruence, be it at the radiocarpal joint or druj, can produce early and often incapacitating pain. Treatment of distal radius fractures orthoguidelines. A malunited radius fracture may be a source of pain for various and often overlapping reasons, each of which must be assessed carefully because each sheds relevance in the selection of treatment. The pendulum swings again for distal radius fracture treatments. Aug 04, 2015 a nonspanning fixator is one which fixes distal radius fracture by securing pins in the radius alone, proximal to and distal to the fracture site. Familiarity with wrist anatomy and the natural history of major fracture types is essential for appropriate management of distal radius fractures 2.
Classifications systems are devised to describe patterns of injury which will behave in predictable ways, to distinguish between conditions which have different outcomes or which need different treatments. The ulna bone may also be broken in younger people, these fractures typically occur during sports or a motor vehicle collision. Distal radius fractures are a common fracture of the arm, with a bimodal peak incidence between the second and third decade and individuals above 65 years of age. Please fax initial evaluation and progress notes to 815. Evans, rb, 2015 1 therapeutic management for distal radius fractures. It assesses the pattern of fractures, involvement of the radioulnar joint and presence of a distal ulnar fracture. Noonan is assistant professor of orthopoedic surgery, indiana university, indianapolis. Typically, these breaks occur when a persons fall causes them to land on outstretched hands. Therapeutic management for distal radius fractures. Distal radius fractures a clinical casebook jeffrey n.
Current concepts in the treatment of distal radial fractures. Begin active range of motion of your fingers immediately and remember to elevate and use ice to control swelling. A distal radius fracture almost always occurs about 1 inch from the end of the bone. This course addresses the rehabilitation of patients with distal radius fractures. The fracture of the distal radius is the most common fracture we treat. Indicated for extra articular or minimal intra articular dorsaly displaced fracture minimum 1 cm of intact volar cortex is required to give purchase for the pins better to preserve volar tilt and.
Anyone who suffers a fracture after age 40, especially postmenopausal women,should be screened for osteoporosis. Distal radius fractures knowledge for medical students. Treatment has long been conservative, especially for elderly. Case immobilization versus immediate pinning was studied in 2 small randomized trials of displaced fractures. A recent prospective study on the national incidence of osteoporosisassociated fractures in a population of more than 200,000 inhabitants revealed drfs as the most frequent fracture type with an annual incidence of 197100,000. Severity of these fractures is directly related to the bone mineral density of the patient, and clinical results are dependent on this parameter as well. An overview article pdf available in journal of family medicine and primary care 34. In patients with complex distal radius fractures, reconstruction of the distal radius, ulna, and triangular fibrocartilage complex can be challenging. The scope of this guideline is specifically limited to acute distal radius fractures. Barton fracture, colles fracture, distal radius fracture, hutchinson fracture, smith fracture fracture of the distal radius is common. Distal radius fractures are one of the most common injuries encountered in orthopedic practice. For example, in a study of fractures occurring in women within a 1year period in dorset, england, the incidence of distal radius fracture rose from a baseline for premenopausal women of 10 per 10,000 population per year to a peak of 120 per 10,000 population per year in women over 85 years 4. Distal radial fracture radiology reference article. One of the most common distal radius fractures is a colles fracture, in which the broken fragment of the radius tilts upward.
Sameer desai paediatric orthopaedic surgeon kem, ruby, sahyadri hospital baramatilast saturday of every month. Oct 01, 20 fractures of the distal end of the radius account for the majority of upper extremity fractures and for up to 15% of all extremity fractures seen in emergency departments. The bony anatomy involves the distal radius, distal ulna and carpal bones. Redisplacement during nonoperative treatment of distal radius fractures may result in symptomatic malunions in any patient. These common fractures usually occur when significant force is applied to the distal radial metaphysis. Distal radius fractures occur through the distal metaphysis of the radius may involve articular surface frequently involving the ulnar styloid most often result from a fall on the outstretched hand. Distal radius fractures broken wrist orthoinfo aaos.
1083 637 337 1266 659 1076 1154 635 686 1363 406 700 452 1192 999 1328 468 814 314 1284 16 23 291 1091 307 1363 1147 337 690 852 994