Makindo Medical Notes

Introduction

A distal radius fracture is a common injury, typically caused by a fall on an outstretched hand (FOOSH). This type of fracture encompasses several patterns, with the Colle’s fracture being the most common. The Colle’s fracture is characterized by a distal radial fracture with dorsal displacement, volar apex angulation, and it is generally extra-articular.

Mechanism of Injury

• Occurs most commonly from a fall on an outstretched hand (FOOSH).
• Other causes include direct trauma to the wrist or high-energy injuries (e.g., motor vehicle accidents).

Fracture Patterns

• Colle’s Fracture: A distal radial fracture with dorsal displacement and volar apex angulation. It is extra-articular.
• Other Patterns: May include intra-articular fractures, comminuted fractures, or fractures with volar displacement (e.g., Smith's fracture).

Clinical Presentation

• Deformity: The classic "dinner fork deformity" seen in Colle’s fractures, where the wrist is dorsally angulated.
• Pain and Swelling: Pain is localized to the distal radius, with significant swelling and tenderness on palpation.
• Patients may have limited range of motion and difficulty using the affected hand and wrist.

Examination

• Assess for the classic dinner fork deformity if the fracture is dorsally angulated, as in a Colle’s fracture.
• Check neurovascular status:
  • Sensation: Assess for numbness or tingling, especially in the median nerve distribution (thumb, index, and middle fingers).
  • Motor: Check for proper finger movement to ensure there is no compromise to nerve function.
  • Pulses: Ensure the radial pulse is present and capillary refill is normal.

Imaging

• X-rays: AP, lateral, and oblique views of the wrist are the standard imaging modalities used to confirm the diagnosis and assess the severity of the fracture. Look for:
  • Dorsal displacement (in Colle’s fractures).
  • Intra-articular involvement.
  • Comminution or shortening of the radius.
• CT Scan: May be needed for complex intra-articular fractures or comminuted fractures that are difficult to evaluate on X-rays alone.

Management

Management of distal radius fractures depends on the type of fracture, displacement, and stability.

• Non-operative: For stable fractures with minimal displacement.
  • Initial management includes a hematoma block for pain control followed by closed reduction to restore radial length and correct dorsal angulation.
  • Closed reduction is often followed by immobilization in a cast (short-arm or long-arm depending on stability) for 4-6 weeks.
• Operative: Indicated for unstable fractures, displaced intra-articular fractures, or fractures that cannot be adequately reduced.
  • Options include open reduction and internal fixation (ORIF) with plates and screws or external fixation for more complex cases.

Factors Affecting Success of Reduction

• Intra- vs. Extra-articular: Intra-articular fractures have a higher risk of complications and may require more precise reduction and surgical intervention.
• Comminution: Highly comminuted fractures are more difficult to reduce and may be less stable after reduction.
• Quality of Cast Mold: Proper molding of the cast is essential to maintain fracture alignment and prevent redisplacement during healing.

Complications

• Malunion: Poor alignment of the fracture can lead to functional limitations and deformity.
• Non-union: Failure of the fracture to heal, particularly in cases where blood supply is compromised.
• Median Nerve Injury: Compression or injury to the median nerve (carpal tunnel syndrome) can occur due to swelling or malalignment.
• Post-traumatic Osteoarthritis: Intra-articular fractures are at risk of developing arthritis in the wrist joint.

Conclusion

Distal radius fractures, particularly Colle’s fractures, are common injuries often resulting from a fall on an outstretched hand. Proper diagnosis, reduction, and management are crucial to prevent long-term complications such as malunion, non-union, and functional impairment. Regular follow-up and imaging are essential to monitor healing and ensure proper alignment of the fracture.