Xray of Malpositioned Volar Barton Fracture In Plaster Cast

Xray of volar Barton fracture in malposition in a plaster cast

AP view

Malreduced Volar Barton Fracture In Plaster Cast - AP View

Malreduced Volar Barton Fracture In Plaster Cast - AP View

Lateral View [Read more...]

United Fracture Distal End Radius WIth Volar Plate In Situ

Following Xrays are of a patient who was operated for fracture of distal end radius using Volar plate. The xray shows volar palte in situ and united fracture of radius.

First the AP view

AP Radiograph Showing United Fracture Radius With Volar Radial Plate In Situ

AP Radiograph Showing United Fracture Radius With Volar Radial Plate In Situ

And now the lateral view [Read more...]

Minimally Displaced Fracture Distal Radius With Extension To Shaft

Xray of 48 years old male showing minimally displaced fracture of distal radius and multiple fracture lines extending to shaft of the radius.

Fracture of Distal Radius Extending To the Shaft

Minimally Displaced Fracture Distal Radius With Fracture Lines Extending To Shaft

The patient was treated with a plaster cast.

Xray of Fracture Of Distal Radius

Lateral View of wrist showing distal radius fracture.

Fracture of Distal Radius

Fracture of Distal Radius

It might be difficult to appreciate on this view but the fracture has intra-articular extension as well.

Injuries of Distal Radius and Ulna Other Than Distal Radius Fracture

Other injuries around the wrist injuries with fracture of distal radius are

  • Radial styloid fractures
  • Isolated volar lip fractures
  • Isolated volar lip fractures
  • Ulnar styloid fractures

Each of this injury indicates a high energy injury to the wrist.

Radial Styloid Fractures

These fractures are associated  scapholunate ligament injuries. Treatment  should include stabilization of the radial styloid with a cannulated screw or K-wires may be used to stabilize the fracture. [Read more...]

Operative Treatment In Distal Radius Fractures

When patient of distal radius fracture is a candidate for operative treatment, there are many surgical options to consider depending on injury and patient characteristics.

The optimal timing of the surgical intervention depends on the associated soft tissue factors and the type of surgical procedure

When fracture is acute, the fracture should be reduced by closed reduction and the surgery should be carriedwhen the swelling is sufficiently reduced. In case of minimal swelling, the surgery can be done immediately.

For arthroscopically assisted reduction and stabilization,  the operative treatment is delayed for at least 3 to 5 days.

Following surgical options can be considered  in surgical treatment of distal radius fracture [Read more...]

Indications For Operative Treatment In Distal End Radius Fractures

Following are the indications for surgical treatment of distal radius fractures.

- Comminuted displaced intra-articular fracture
- Open fractures
- Associated carpal fractures
- Associated neurovascular injury or tendon injury
- Failed conservative treatment
- Bilateral fractures
- Impaired opposite limb

Non Operative Treatment of Distal Radius Fractures

For years distal radius fractures had been managed by closed reduction and cast application. However, the paradigm has changed with better understanding of distal radius anatomy and better gadgets.

Now the treatment with closed reduction and cast immobilization is indicated in
1. Stable fractures in which the the goals of treatment can be expected to be achieved.

2. Patients with low functional demands.

Stable Fractures

Stable fractures can be considered for non operative treatment depending on fracture type and and patient.

There is no particular criteria as to  which fracture is to be considered stable and which not but following things needs to be considered. These factors have been associated with redisplacement after cast immobilization

  • A fracture combined with ligamentous injury is an unstable fracture
  • Greater initial displacement of the fracture
  • Elderly age
  • Metaphyseal comminution
  • Displacement after closed treatment

Patient Demands

If the patient has a low functional demand he or she may not choose to undergo surgery though recent studies have suggested better outcomes of surgery in active elderly patients.

The decision therefore must also consider  physical demands, health status, independent lifestyle, vocation, , and other comorbid conditions.

Technique of Closed Reduction of Distal Radius Fracture

Anatomical Considerations In Treatment Of Distal Radius Fractures

The distal radius is made up of metaphysis and  three articular surfaces

  • Laterally the scaphoid facet
  • Medially, the lunate facet
  • Sigmoid notch for distal radio ulnar joint

The ulna plays an important part of the ligamentous integrity of the DRUJ and TFCC.

The metaphysis is flared distally in both the AP and the lateral planes.

There is a thin cortical bone on dorsal and radial aspect making the fractures typically collapse dorsoradially. [Read more...]

Sauve Kapandji Procedure

Sauve Kapandji procedure involves removal of about 10 mm of ulna proximal to distal radio ulnar joint and fixing teh distal fragment of ulna to radius by means of screw. This aims at creating a new joint at teh level where ulna is cut and serves two purposes The procedure unloads the ulnar bone so that more force is transmitted to the radius instead of the triangular fibrocartilage and at the same time provides a distal stabilization.

The image below illustrates the point. [Read more...]