Complex regional pain syndrome(CRPS) (2-20%).Nonunion: uncommon except with volar and dorsal plating with extensive sub-periosteal stripping.Malunion = typically loss of radial height, ulnar and volar inclination less commonly inarticular incongruity.Galeazzi Fracture: highly associated with distal 1/3 radial shaft fractures.Tendon injury,attritional EPL rupture, usually treated with EIP tendon transfer.Carpal ligment injury:Scapholunate Instability(most common), lunotriquetral ligament.TFCC injury, up to 50% when ulnar styloid fx also present.Scapholunate ligament tear: occurs in Median nerve injury.Used to occur then cars backfired while they were being crank started.Ĭolles' Fracture fracture Associated Injuries / Differential Diagnosis Chauffeur' Fracture's fracture = intraarticular fracture of the base of the radial styloid.Smith's fracture = reverse Colles' fracture may be caused by backwards fall resulting in forced wrist pronation.Barton's Fracture = a fracture-dislocation of the radiocarpal joint in which the carpus displaces with either a volar (volar Barton's Fracture) or dorsal fragment (dorsal Barton's Fracture) of the distal radius.Colles' Fracture = dorsally displaced fracture of the distal radius generally occuring 2-3 cm proximal to the radiocarpal joint.Consider Osteoporosis evaluation and management.(AAOS Clinical Practice Guideline, 2011)Ĭolles' Fracture Classification/Treatment
3mm, dorsal tilt >10º, intra-articular displacement or step-off >2mm.CT (3-dimensional) improves recongnition of articular comminution and may aid in pre-operative planning (Harness NG, JBJS 2006 88A:1315).ĭistal Radius Fracture Acceptable Reduction.MRI if TFCC or scapholunate ligment tears suspected.1mm-2mm sagital CT best to view articular depression fx.Signs of DRUJ injury: fracture at the base of the ulnar styloid, widening of the DRUJ space seen on the P/A xray, >20° of dorsal radial angulation, and >5 mm of proximal displacement of the distal part of the radius.And measure the distance to the tip of the radial styloid. Draw a line perpendicular to the long axis of the radius intersecting the distal articular surface of the ulnar head. Radial length: best measured on true PA radiographs of both wrists for comparision.Assess ulnar variance, carpal alignment and sigmoid notch conguence. Normal radiographic parameters: Radial inclination=23°,radial length=12mm, volar tilt=11°, scapholunate angle = 60° +/-15°. Generally have gross deformity to the wrist with dorsal and lateral displacement, "dinner fork" deformity. Dorsal cutaneous branch of ulnar n arises deep to FCU, becomes SQ 5cm from pisiform-has multiple branchesĬolles' Fracture fracture Clinical Evaluation.Palmar cutaneous branch of the Median nerve arises from the Median nerve proximal to the volar wrist crease and travels between the FCR and median nerve.Palmar branch passes within 2cm of 1st dorsal compartment provides sensation to dorsolateral thumb after passing directly over EPL. Sensory branch of radial nerve becomes subcutaneous 5-10cm proximal to radial styloid in interval between brachioradialis and ECRL.Radial inclination=23°,radial length=12mm, volar tilt=11°, ulnar variance -0.6mm, scapholunate angle = 60° +/-15°.Distal radius 3 column anatomy: Radial column (strong cortical bone), Intermediate column (contains lunate facet and sigmoid notch) Distal ulna column (contains TFCC) (Rikle DA, JBJS 1996 78Br:588).ROM-80°dorsiflexion, 85°palmarflexion, 90°pro\sup,25°radial deviation,35°ulnar deviation.The distal radius scarries 80% of axial load.Colles' fractures = 90% of distal radius fractures.Distal radius fractures are the most common fx of UE.Mechanism of injury = fall on an outstretched and dorsiflexed hand.
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