Mx of distal radius fractures
- 1. MANAGEMENT OF DISTAL RADIUS FRACTURES Dr. HARSHA NANDINI TALASILA M.S Ortho
- 2. CLOSED REDUCTION • All fractures must undergo closed reduction,even if it is expected that surgical management will be needed Fracture reduction helps : • To limit postinjury swelling • Provides pain relief • Relieves (if any) compression on the median nerve.
- 3. Indications for Closed Treatment • Non displaced or minimally displaced fractures • Displaced fractures with a stable fracture pattern which can be expected to unit within acceptable radiological parameters • Low demand elderly patients in whom future functional impairment is less of a priority than immediate health concerns and or operative risks
- 4. Technique of Closed Reduction Anesthesia • Hematoma block • Intravenous sedation • Bier block Reduction Maneuver (dorsally tilted fracture): • Distal fragment is hyperextended • Traction is applied to reduce the distal to the proximal fragment with pressure applied to the distal radius. Apply well-molded splint or cast. Check X-ray to confirm the acceptable reduction.
- 5. • Once the swelling is subsided,a well molded cast is applied. • The splint should leave the Metacarpophalyngeal joints free. • The cast should be worn for 6 weeks or until radiological evidence of union has occurred. • The patient should be adviced full range of finger motion during immobilization to minimize finger stiffness
- 6. RADIOLOGICAL CRITERIA FOR ACCEPTABLE REDUCTION OF DISTAL RADIUS FRACTURE CRITERIA NORMAL ACCEPTABLE Ulnar variance +/-2mm comparing level of lunate facet to ulnar head No more than 2mm of shortening relative to ulnar head Palmar tilt 11 degrees volar tilt Neutral Radial inclination 20 degrees as measured from lunate facet to radial styloid No less than 10 degrees Intraarticular step or gap None Less than 2mm
- 8. Indications for Surgical Treatment 1. High-energy injury 2. Secondary Loss of reduction 3. Comminuted displaced intraarticular fracture,step off 4. Metaphyseal comminution or bone loss 5. Open injury 6. Assosciated carpal fractures 7. Assosciated neurovascular or tendon injuries 8. Bilateral distal radius fractures 9. An impaired contralateral extremity 10. DRUJ incongruity
- 9. PERCUTANEOUS PINNING • Anatomic reduction is obtained first and then stability is provided by K wires • Pins: radial styloid across to the medial radial metaphysis and diaphysis. • Atleast 2 pins are applied. • Confirm reduction on AP and lateral views.
- 11. Internal Fixation of Distal Radius Fractures • elevation of depressed articular fragments • required if articular fragments can not be adequately reduced with percutaneous methods
- 12. Selection of Approach Volar approach is most commonly used Dorsal approach • Dorsal die punch fractures • Displaced dorsal lunate facet fragments
- 13. VOLAR
- 18. External fixation • Method of choice for fractures with intra-articular components and extensive metaphyseal comminution. • TYPES: 1. NON SPANNING 2. SPANNING 3. AUGMENTED EXTERNAL FIXATION
- 19. Pin Placement
- 22. • NON SPANNING EXTERNAL FIXATION: minimally comminuted extraarticular. Simple articular fractures with good bone stock
- 24. DISTRACTION PLATE FIXATION • Alternative to external fixation • The plate is applied to the dorsal surface of the hand,wrist and distal forarm using 3 small incisions. • External fixation pin site problems are avoided. • The plate is in place as long as necessary for union.
- 26. AUGMENTED EXTERNAL FIXATION • External fixation Along with Cross K wire Fixation. • One k wire through the radial styloid • One through the dorsal ulnar fragment into the radial shaft
- 27. FRAGMENT SPECIFIC OPEN REDUCTION INTERNAL FIXATION OF COMMINUTED DISTAL RADIUS FRACTURES • 5 potential fracture fragments: 1. Radial column 2. Dorsal cortical wall 3. Dorsal ulnar split 4. Volar rim 5. Central intraarticular fragment
- 31. COMPLICATIONS OF DISTAL RADIUS FRACTURES • Malunion Results from inadequate fracture reduction or stabilization Treated with osteotomy and internal fixation and bone grafting • Finger,wrist and elbow stiffness • Median nerve dysfunction • Tendon rupture: extensor policis longus tendon • Posttraumatic osteoarthritis • Midcarpal instability
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