Distal Radius Fracture

Scenario

A 62 year old female presented after a fall onto an outstretched hand.

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This is a lateral and AP plane film radiograph of a skeletally mature individuals Left wrist. The Most obvious abnormality is that there is an intra-articular distal radius fracture. There is a positive ulnar variance sign. The radius is dorsally tilted, shortened and radial inclination is not maintained. Classification would be according to the Frykman Classification and this would correspond to a Frykman 3. Eponymous name = Dorsal Bartons.

Frykman Classification (based on joint involvement (Radiocarpal and/or radioulnar) +/- ulnar styloid fracture

1

Extra-articular

2

Extra-articular + ulnar styloid

3

Radio-carpal joint

4

Radio-carpal joint + ulnar styloid

5

Radio-ulnar joint

6

Radio-ulnar joint + ulnar styloid

7

Radio-ulnar and Radio-carpal joint

8

Radio-ulnar and Radio-carpal joint + ulnar styloid

 

  • Radial height 11mm (Acceptable <5mm)
  • Radial inclination 22 degrees (Chase <5 degrees)
  • Articular step-off congruous (<2mm)
  • Volar tilt (Lateral) 11degrees (within 20 degrees of contralateral distal radius or <5degrees dorsal angulation)

  • Patients were aged > 18 years with a dorsally displaced fracture within 3cm of the radiocarpal joint
  • Injury was <2 weeks old
  • No difference between volar locking and Kirschner wire fixation

In an appropriately marked and consented and anaesthetised patient. I would complete the WHO checklist.

I would position the patient in the supine position with an arm board.

Torniquette to 210mmhg

  • Incision would be via the FCR approach
  • I would make an incision 10cm along the palpable flexor carpi radialis ending at the palmar crease.
  • Inter-nervous plane is between the Median nerve and Anterior interosseous nerve
  • Superficial dissection between Flexor carpi radialis and radial artery
  • Deep dissection involves resecting the Flexor pollicis longus ulnarly and incising the radial and distal borders of the PQ
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