Bend the kwire out of the way to facilitate drilling. We conclude with a series of questions the radiologist should address in the initial description of. Many different fracture patterns can occur when the distal radius is fractured and often medical eponyms such as colles fracture do not fully describe the extent of the injury. Despite the high incidence of distal radius fractures, around. Definition o chronic stress injury of distal radial physis o also known as epiphysiolysis 2. One of the most common distal radius fractures is a colles fracture, in which the broken fragment of the radius tilts upward. During the european congress of trauma and emergency surgery ectes 2015 a 20question multiplechoice survey was conducted among the attending. Symptoms a broken or fractured wrist usually causes immediate acute pain, tenderness, bruising, and swelling. Delince department of orthopaedic surgery, hital saintpierre, brussels, belgium a total of 112 consecutive cases of fractures of the distal radius managed conservatively were graded according to radiological criteria using the first radiograph. The ulna bone may also be broken in younger people, these fractures typically occur during sports or a motor vehicle collision.
It also occurs in young men with high velocity, injury. The radial inclination of a distal radius fracture is shown in red in image at right. General info o common injury in pediatric gymnast o diagnosis made by history and physical exam confirmed with plain xrays or mri treatment often nonsurgical. Management, fracture reduction, and casting of distal forearm fractures and the care of pediatric midshaft forearm fractures is discussed separately. It is due to palmar tensile stress and dorsal shear stress and is usually combined with radial styloid fracture. Lee, md, new york, ny presents the arthrex volar distal radius plate technique. An overview article pdf available in journal of family medicine and primary care 34.
The plates are anatomically contoured and may help restore the bones natural anatomy from the distal ulnar side to the radial styloid. Colles fracture specifically is defined as metaphyseal injury of cortico. Operative treatment options are open reduction and internal fixation or. Korean type distal radius anatomical volar plate system. There is little guidance in the current literature as how to manage these fractures and their associated injuries.
Therapeutic alternatives for distal radius fractures. Distal radius fractures occur through the distal metaphysis of the radius. Distal radius fractures orthopaedic trauma association. Polyaxial locking screws up to 10 trajectory variation. Modality of treatment for the distal end radius fracture. Screw trajectories are designed to provide optimal subchondrial support. Intraarticular distal radius fracture treatment using plate and screw fixation aculoc 2 wrist plating system case study hnw70a case. Acumed has introduced the aculoc 2 volar distal radius vdr plating system as the next generation in plating fixation.
A thorough understanding of the pathophysiology and treatment of distal radius fractures is important because these injuries are not limited to just the elderly population. Distal radius anatomy applied to the treatment of wrist. Treatment of distal radius fractures with volar locking. A distal radius fracture almost always occurs about 1 inch from the end of the bone. A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist.
External fixation of distal radius fractures may be used in a bridging or nonbridging manner. Redisplacement of distal radius fracture after initial closed. Ppt distal radius fractures powerpoint presentation. Bridging external fixation of distal radius fractures typically relies on ligamentotaxis to obtain and maintain a reduction of the fracture fragments. Mar 29, 2019 how to classify distal radius fractures. Six months after a conservatively treated distal radius fracture the mean arc of flexion and extension and the forearm rotation were know to be 75% to 97% and 87 to 97%, respectively, compared with the uninjured side 610.
This type of fracture was first described by an irish surgeon and anatomist, abraham colles, in 1814. Complex distal radius fracture treatment using plate fixation aculoc 2 wrist plating system case study hnw7012a case study. A comprehensive offering of volar plates are available in narrow, standard, and. A line drawn between the distal ends of the articular surface of the radius on a ap view of the wrist. Intraarticular fractures of the radius can be arthroscopically assessed, and reduction of the articular components and assessment and repair of ligamentous injury can then be undertaken. This site is an academic site devoted to studying distal radius fractures and is open to all surgeons. Adaptive volar radius plates for very distal placement and. Acumed aculoc dorsal plates are designed for complex distal radius fractures that need to be addressed from the dorsal side. Reliable internal fixation for the comminuted or osteoporotic distal radius fracture finally be came available with the introduction of fixed angle fixation implants.
To further assist with complications of wrist fractures, osteotomies, and other wrist injuries, acumed has introduced three additional plate families to the system. Distal radius fractures are one of the most common injuries encountered in orthopedic practice. Made of continuous carbon fibers reinforced polymer. Guide inserts starting on the ulnar side in order to stabilize the lunate fossa figure 15.
Familiarity with wrist anatomy and the natural history of major fracture types is essential for appropriate management of distal radius fractures. External fixation of distal radius fractures clinical gate. Distal radius and ulnar fractures musculoskeletal key. Feb 19, 2019 distal radius fractures account for approximately 15% of all fractures in adults. A comprehensive offering of volar plates are available in narrow, standard, and wide as well as multiple shaft lengths.
It occurs in middle aged and elderly women commonly. Associated injuries may accompany distal radius fractures. Since its release, over 200,000 aculoc volar distal radius plates have been implanted globally. As longitudinal traction is applied to the carpus, the tension is transmitted mostly through the. A line that is perpendicular to the diaphysis of the radius.
Distal radius fracture is the most common fracture of the upper extremity, with an annual incidence of 2 to 4 per 1,000 persons. This elevated posture likely represents a significant risk factor that has played a role in drfs being the most common fracture treated by physicians. Korean type distal radius anatomical volar plate system clinics in orthopedic surgery vol. Distal radius fractures typically occur with the wrist bent back from 60 to 90 degrees. When this happens, it is called a distal ulna fracture. Distal radius fractures most common ue fx 1 out of 6 fractures seen in er 3rd most common fracture high morbidity rate. Background the radius is the most common bone in the arm to sustain a fracture. Classification of distal radius fractures wikipedia. Choose the appropriate implant according to patient anatomy and fracture pattern. Aculoc 2 volar distal radius plating system surgical.
Volar correction plates indicated for correction osteotomies and extension fractures with radial defect. Reported lifetime risks of distal radius fractures from the age of 50 onwards range from 12% to 52. The distal radius is the most common fracture site in the upper extremity. The significance of distal ulnar fractures is often not appreciated and often results in inadequate treatment in comparison to its larger counterpart. Classification, the definition of an acceptable reduction and indications for surgery in distal radius fracture management are still subject of debate. It involves an intraarticular fracture of radial styloid of variable size. Fall with dorsiflexion and pronation of the distal forearm on a flexed wrist. Distal radius fractures disclosures i have stock ownership in johnson and johnson and pfizer. Volar plate fixation of distal radius fractures miami hand. Straight plates, precontoured to fit the radial column, have a notched tip that allows these plates to fit on the radial styloid adjacent to a temporary kwire fixation.
The management of distal ulnar fractures in adults. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The plate should be placed slightly below the distal edge of the radius to support the volar articular fracture. Distal radius fractures common injury fractures of the distal radius represent approximately 16% of all fractures treated by orthopaedic surgeons three main peaks of fracture distribution. The evolution of distal radius fracture management a. One study found that only 2 9% of collesfound that only 2. Distal radius anatomy applied to the treatment of wrist fractures by plate. Various factors affect secondary displacement of fracture fragments after anatomic or near anatomic. The insertion of the brachioradialis may be released. Distal radius fractures are the most common fractures of the human skeleton, with about ten per cent of the population sustaining a fracture at some point in their life.
Ppt distal radius fractures powerpoint presentation free. Numerous methods for reduction and fixation have been published. Novel dual head minimizes plate profile, reducing the potential for flexor tendon injuries. General info o common injury in pediatric gymnast o diagnosis made by history and physical exam confirmed with plain xrays or mri treatment often nonsurgical rest until pain free. Screw holes accommodate both locking and nonlocking screws. Frykman called our attention to the importance of injuries on the ulnar side of the wrist to outcome of distal radius fractures. We conclude with a series of questions the radiologist should address in the initial description of fracture involving the distal radius. The radius narrows toward its distal end close to the wrist joint, and fractures at this weakest point are very common. Such injuries account for approximately onesixth of fractures treated in united states emergency departments eds.
Classification and treatment of distal radius fractures. The goal of the site is to present a comprehensive inventory of distal radius fracture management information and resources, as well as uptodate. The anatomic midshaft forearm plating system includes midshaft ulna plates, volar midshaft plates, and dorsolateral midshaft radius plates. Associated fractures of the distal ulnar metaphysis were present in 19 of 320 distal radial fractures requiring either closed manipulation or surgical treatment over a 2year period. Acumed distal radius plate pdf november, 2018 in, acumed introduced the aculoc targeted volar distal radius plate system for acumed aculoc wrist plating system surgical technique. In fact, the radius is the most commonly broken bone in the arm. Intraarticular component in distal radius fractures usually signifies highenergy trauma. Distal radius fractures have been a common affliction for millennia, but their treatment is a more recent development as a result of human erudition. Modality of treatment for the distal end radius fracture dr bhuvnesh chaturvedi, dr sk irfan ali, dr sumit krishna abstract fracture of the distal end of radius is one of the most common fractures. Specific qualitative and quantitative features of the distal radius fracture apparent on the radiograph are discussed. The titanium volar plates are available in a wide array of sizes narrow, standard, and wide and in multiple shaft lengths. Stability assessment of distal radius fractures sciencedirect. Fractures of the distal radius often have beeu considered primarily extraarticular injuries of elderly females. The distal ulna represents the fixed point around which the radius and the hand acts in daily living.
This fracture was first described in 1814 by an irish surgeon and anatomist. Symptoms include pain, bruising, and rapidonset swelling. Gymnasts wrist distal radius growth plate injury background 1. Furthermore, a fresh look at distal radius biomechanics shows that the loads experienced by the distal radius vary greatly.
This disk is then attached by thick tissue to the base of the ulnar styloid and by thinner tisthe distal radioulnar joint peter c. The traditional treatment of distal radius fractures was either nonoperative, with closed reduction and cast immobilisation, or operative. Distal radius fracture is one of the most common fractures seen by. Geminus volar distal radius plate skeletal dynamics.
The purpose of this study was to characterise current distal radius fracture management in europe. Nathan edwin lesley, md uses the acumed aculoc 2 wrist plating system to treat a 63yearold female who presented with a chronic malunion of the distal radius from a fracture treated nonoperatively five years earlier. Distal radius fractures scott wolfe md upper extremity surgeon. While immobilization has served as the only available treatment for most of our history, many advances have been made in the management of distal radius fractures over the last century as the. Distal radius fractures broken wrist orthoinfo aaos. Abraham colles is credited with description of the most common fracture pattern affecting distal end radius in 1814, and is classically named after him. There are around 120,000 fractures per year in the united kingdom and 607,000 annually in the united states1,2 with a. Fractures of the distal radius are common and account for an estimated 17 % of all fractures diagnosed1,2. Reliably restoring volar tilt of distal radius fractures. However, there are increasing reports of distal radial fractures causing serious articular dmnage and profoundly affecting the wrists of a greater population. A distal ulna excision had previously been performed for ulnocarpal impaction. The distal radius fracture drf is an injury that predates our species, with a significant milestone in our evolution being the transition to bipedal ambulation by australopithecus.
Most often result from a fall on the outstretched hand. Dvr crosslock distal radius plating system surgical technique. The titanium wrist plating system technique is designed for fixation of intraarticular and extraarticular fractures, osteotomies, as well as nonunions and malunions of the distal radius. Welcome to eradius, the website of the international distal radius fracture study group. The break can occur in many different ways, however. Incidence rates of surgical treatment of a distal radius fracture varied between 4. The characteristics of distal radius fractures are influenced by the position of the hand at the time of impact, the type of surface at point of contact, the speed of the impact, and the strength of the bone. The system presents several plate options, a unique twopiece locking compression screw, innovative instrumentation for fracture management, and plate placement tools. When a distal radius fracture occurs, it contributes to considerable disability, increased dependence for the injured patient and causes a major challenge for health care systems. Acumed distal radius plate pdf posted on january 8, 2019 by admin in, acumed introduced the aculoc targeted volar distal radius plate system for acumed aculoc wrist plating system surgical technique. In older people, the most common cause is falling on. Mcqueen introduction classification epidemiology risk factors assessment treatment complications references introduction fracture of the distal radius is the most common fracture encountered by orthopaedic trauma surgeons.