Relatively few patients with a malunited distal radius fracture need a corrective osteotomy or salvage procedure. Distal radius fracture is one of the most common fractures accounting for around 25% of fractures in the pediatric population and up to 18% of all fractures in the elderly age 1 nellans kw, kowalski e, chung kc. Corrective osteotomy for volarly malunited distal radius fracture. In contrast, unstable fracture easily becomes malunited with inadequate treatment. Show full abstract malunited distal radius fracture. Distal radius fractures account for approximately 15% of all fractures in adults. Diepunch fracture a depression fracture of the lunatefossa of the distal radius. Ppt distal radius fractures powerpoint presentation. Our new crystalgraphics chart and diagram slides for powerpoint is a collection of over impressively designed datadriven chart and editable diagram s guaranteed to impress any audience.
Figure w12 anterior volumerendered 3d reformatted image from a multidetector ct examination allows improved appreciation of the degree of fracture displacement of the distal radius, allowing the clinician to anticipate surgical findings frequently, subtle radiographic lucencies of the distal radius may simulate fractures and are a cause for inconclusive, or even incorrect, reporting. Compressive neuropathy is one of the most important complications of distal radius fractures involving the median nerve. Report by bulletin of the nyu hospital for joint diseases. The overall complication rate of distal radius fractures ranges from 6% to 80% and has been associated with poor functional outcomes. Using a bone substitute, the operation can be performed as an outpatient procedure and donorsite pain avoided. Possible bony reasons consist of intraarticular incongruency, malalignement of the sigmoid notch of the distal radius or the ulnaplussituation at the wrist level. Since distal radius fracture is a debilitating injury that causes a significant burden to the individuals and society, it should be treated effectively and safely in the shortest time after the injury to obtain best outcome. Relationship between distal radius fracture malunion and arm.
Malunion of a distal radius fracture may result in functional limitation and pain. With positive ulnar variance, the normal load on the ulnar carpus of approximately 18 % increases up to 65 % 18. Note the dorsal posture of the lunate and the increases in the scapholunate angle and the capitolunate angle. Distal radius fracture is one of the most common fractures accounting for around 25% of fractures in the pediatric population and up to 18% of all fractures in the elderly age. Involvement of the druj in distal radius fractures is similarly underestimated on radiographs compared with ct. Dr vikas gupta malunited distal radius fractures olwa 2018 duration. Anterolateral surgical approach to the malunited distal radi. Symptoms include pain, bruising, and rapidonset swelling. Dinner fork deformity, also known as a bayonet deformity, occurs as the result of a malunited distal radial fracture, usually a colles fracture. Fracture of the distal radius is a common injury, and the outcome differs depending on the type of fracture. After a severe trauma, a 16yearold female patient sustained multiple injuries, including a distal radius fracture of the left arm. Similar to a malunited distal radial fracture, an ununited fracture of the distal radius commonly is associated with residual derangement of the distal radioulnar joint druj.
Corrective osteotomy of the distal radius is a well accepted procedure in younger, manual working and active patients with a malunited distal radius fracture. Distal radius fracture is a common injury and may result in substantial dysfunction and pain. Each chapter offers a comprehensive guide to the diagnosis and treatment of a specific fracture, including possible complications. Chart and diagram slides for powerpoint beautifully designed chart and diagram s for powerpoint with visually stunning graphics and animation effects. Interpretation osteotomy of the distal radius is effective in increasing motion and grip strength after a malunited distal radial fracture. It also occurs in young men with high velocity, injury. Indications for operative fixation of distal radius. Malunion of the distal radius usually occurs following conservative treatment. Low energy injury usually fall from standing height is the usual cause of distal end radius fracture 66 to 77% of cases. Unless youve ever lived in a cast for a couple months, you just cant imagine how completely odd and orgasmic it feels to be cut free. The introduction of a new volar plate with subchondral support fixation allows the treatment of most distal radius fractures with stable internal fixation and early motion while avoiding the complications inherent in the dorsal approach. Different modalities of distal end radius fracture treatment. Small incisions may be made to assist with reduction and a small osteotome or freer used to manipulate fragments, if needed. We describe two possible mechanisms of injury for these rare.
Although it is common for separate elbow joint dislocation and fracture of forearm bones to occur, it is a rare sighting for both elbow dislocation and ipsilateral fracture of the distal radius. The distal radius fracture is reduced in a closed fashion utilizing multiplanar ligamentotaxis, distraction and manipulation to reduce the fracture anatomically. Nearly 90 000 older adults in the united states experience distal radius fractures drfs annually. Chauffeurs fracture hutchinsons an isolated fracture of the radialstyloid process displacement of. Early correction of paediatric malunited distal metaphyseal. The distal part of the anterior henry approach involves exposure between the flexor carpi radialis and radial artery. Normally stable distal radius fracture is treated nonoperatively with a favorable result. W1 role of advanced imaging in distal radius fractures. Average age of occurrence is between 57 and 66 years. Nineteen patients had a fracture of the distal onequarter of the radius and two had a salter grade ii injury. Pa and lateral of a malunited distal radius fracture with some loss of radial height and inclination with significant dorsal tilt and adaptive disi deformity while malunion can result in multiple changes in mechanics and may ultimately lead to arthrosis, the decision to perform a corrective osteotomy for a distal radius malunion should.
Fractures of the distal radius are extremely common injuries, which are steadily becoming a public health issue. Fracture of the distal radius is the most common fracture encountered by orthopaedic trauma surgeons. Winner of the standing ovation award for best powerpoint templates from presentations magazine. Do young patients with malunited fractures of the distal.
In this case, we demonstrate our preoperative lowcost workup for threedimensional 3d planned and assisted corrective osteotomy of a malunited distal radius fracture using an inhospital 3d printer. We report a case of an anterior dislocation of the elbow with ipsilateral fracture of the distal radius. Distal radius and ulnar fractures musculoskeletal key. Secondary procedures following a distal radius fracture. Malunion is a major complication of fractures involving the distal radius and ulna 3, seen in up to 33% of cases 4. Assessment of anatomic restoration of distal radius. Health, general arm care and treatment injuries arm injuries internal fixation health aspects usage internal fixation in fractures medical societies practice guidelines medicine analysis. Patient satisfaction is high and subjective results measured with dash are good. Major complications of distal radius fractures include carpal. Ulnar variance has important prognostic implications. 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. The epidemiology of distal radius fractures hand clin 2012. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. 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.
Men who sustain distal radius fractures are usually younger, generally in their 40s vs. There are around 120,000 fractures per year in the united kingdom and 607,000 annually in the united states 1, 2 with a peak in incidence in the older patient, particularly in females. Surgical correction of malunited fractures of the distal radius. Reestablishing the geometry of the metaphysis and the alignment of the articular surface, restoring the relationship at the distal radioulnar joint, and respecting the softtissue envelope are elements of a successful reconstruction. Ppt distal radius fractures powerpoint presentation free. Reported lifetime risks of distal radius fractures from the age of 50 onwards range from 12% to 52.
Malunion of the distal radius, archives of orthopaedic and. When bone graft is required, this may necessitate a separate incision and further add to the morbidity. This distal radius fracture eventually developed into a malunion. Management of posttraumatic malunion of fractures of the. Difficulties with the dorsal approach discourage surgeons from internally fixing the most common fracture types. Mar 07, 2019 pa and lateral of a malunited distal radius fracture with some loss of radial height and inclination with significant dorsal tilt and adaptive disi deformity while malunion can result in multiple changes in mechanics and may ultimately lead to arthrosis, the decision to perform a corrective osteotomy for a distal radius malunion should. The purpose was to investigate the relationship between distal radius fracture malunion and armrelated disability. Midcarpal instability caused by malunited fractures of the distal radius thirteen patients with malunited fractures cf the distal radius developed symptoms of pain and instability of the midcarpal joint. Ulnar shortening osteotomy after distal radius fracture. The ulna bone may also be broken in younger people, these fractures typically occur during sports or a motor vehicle collision. Fracture of the distal end of radius represent the most common fracture of the upper extremity comprising approximately 8%17% of fractures seen in the emergency department 2 as per literature. High energy injuries accounts for 10% of wrist fractures. A persisting luxation of the distal radioulnar joint druj will present itself with complete.
The prospective populationbased cohort study included 143 consecutive patients above 18 years with an acute distal radius fracture treated with closed reduction and either cast 55. B,normal radiocarpal and intercarpal alignment in the sagittal plane. Corrective osteotomy of malunited distal radius fractures. Chauffeurs fracture hutchinsons an isolated fracture of the radialstyloid process displacement of the fragment isuncommon. Relationship between distal radius fracture malunion and. Corrective osteotomy for volarly malunited distal radius.
Best approaches in distal radius fracture malunions. Staged reconstruction for malunited fractures of the distal. This attempted to eliminate any symptoms present from other. The current study aimed to clarify the 3d deformity patte. Although sometimes stated otherwise, the outcome of these fractures is not uniformly good regardless the treatment instituted. Malunion causes pain, deformity, motion range limitation, and loss of strength. Current trends in the management of distal radius fractures. The reported prevalence of median neuropathy after colles. This can be altered with fracture of the distal radius 15, 17. Corrective osteotomy to restore normal anatomy usually provides improved function and significant pain relief. In six cases, a recurrent voluntary midcarpal subluxation was also present during ulnar deviation.
Jan, 2011 distal radius fracture is a common injury and may result in substantial dysfunction and pain. Clinically most patients complain about ulnar sided wrist pain and limited forearm rotation following malunited distal radius fractures. The most common deformity following a malunited extraarticular fracture of the distal radius is the loss of the normal palmar tilt of the articular surface in the sagittal plane, and loss of length relative to the ulna. In older people, the most common cause is falling on. Anterolateral surgical approach to the malunited distal.
Indications for operative fixation of distal radius fractures. Osteotomy of dorsally displaced malunited fractures of the. Feb 01, 2012 fractures of the distal radius are extremely common injuries, which are steadily becoming a public health issue. Little information exists about threedimensional 3d deformity patterns of malunited distal radius fractures including axial deformity. Distal radius malunion is a major complication of distal radius fractures, reported in 0 to 33% of cases. Ultrasound evaluation of carpal tunnel and median nerve in. The malunited distal radius fracture early or late. Fractures of the distal radius linkedin slideshare. Staged reconstruction for malunited fractures of the. Carpal instability, malunion among complications of distal. Threedimensional deformity analysis of malunited distal. Distal radius fracture problems can arise from complications related to the soft tissues, bony anatomy, joints and hardware. Modality of treatment for the distal end radius fracture.
The fracture of the distal radius is the most common fracture we treat. It occurs in middle aged and elderly women commonly. Malunion of distal radius fracture often causes discrepancy in the wrist with a long ulna relative to the radius manifesting with ulnar wrist pain, swelling, and limitation of wrist motion. By applying a 1020 angle in the lateral projection, paralleling the articular surface of the distal radius, visualization of the articular surface is improved as a result of normal radial inclination. The conditions responsible for limited forearm rotation are incongruity, impaction, and stiffness caused by palmar capsular contracture and instability of the druj.
Correction of nascent malunion of distal radius fractures. Recently there has been more interest in the outcome of. The reported prevalence of median neuropathy after colles fracture has ranged from 0. Jul 15, 2014 malunion of the distal radius usually occurs following conservative treatment. We present an alternative anterolateral surgical approach to the distal radius, which allows for excellent exposure, and minimal trauma to the tendons while permitting harvest of local bone graft through the same incision. In the other hand, unstable fracture easily becomes malunited with inadequate treatment. Davis and jabulani sithole, journalthe journal of bone and joint surgery. Malunion is a major complication of fractures involving the distal radius and ulna, seen in up to 33% of cases. Distal radius fractures are the most common long bone fracture. Because there is little space available on the dorsal aspect of the distal radius, implant related extensor tendon problems were reported and these tempered the enthusiasm for the new technique 1,810,12,1421. The muscle belly of the flexor pollicis longus is retracted ulnarly to expose the pronator quadratus, which is elevated from its insertion on the radius fig. A rare combination of complex elbow dislocation and distal.
Apr 20, 2012 diepunch fracture a depression fracture of the lunatefossa of the distal radius. Stable distal radius fracture is usually treated nonoperatively with a favorable result. Malunion of distal radius fracture often results in radial shortening as the main deformity, with disturbed radioulnar variance, quite often associated with lesions of triangular fibrocartilage complex. Fractures of the distal radius are extremely common injuries and the outcome differs depending on the type of fracture. 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. Aro and koivunen4 classified three types of radioulnar relationships at the druj after distal radius. Out of the total number of cases n412 for fracture distal end radius, 5012% cases were managed with cast, 9122%with percutaneous fixation with kwire, 98 with external fixature, 78. May 25, 2017 to help clarify the indications for surgical correction of malunited distal radius fracture with dorsal angulation of 10 to 20, chen et al 10 used 3dimensional computed tomography.
At the time of diagnosis, the mean posterior tilt was 25 range, 8 to 72 and the mean radial inclination was 9 range, 0 to 25. 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. Colles fractures remain one of the most challenging of fractures that can be treated nonoperatively. Surgical correction of malunited fractures of the distal.
Reestablishing the geometry of the metaphysis and the alignment of the articular surface, restoring the relationship at the distal radioulnar joint, and respecting the softtissue envelope are elements of a. Malunited distal radius fractures 272 journal of the american academy of orthopaedic surgeons moid notch and then measuring how much of the ulnar head is distal to that line fig. Complications of distal radius fracture fixation may arise from the injury or method of treatment, as well as both. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect.
1441 331 1463 745 341 1369 1382 1396 879 107 341 583 1377 337 1274 1061 1236 1421 1057 1477 1014 267 1364 1332 1496 208 1280 283 925 524 363 1135 140 583 223 1070 414