Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
Traumatology and orthopaedics
Acute Trauma Management
Trauma in perspective
Principles of Primary Trauma Care
Six phases of Primary Trauma Care
Procedures
Orthopaedic Techniques
Traction
Casts and Splints
Application of external fixation
Diagnostic imaging
Physical therapy
Crania burr holes
Orthopaedic Trauma
Upper extremity injuries
The hand
Fractures of the pelvis and hip
Injuries of the lower extremity
Spine injuries
Fractures in children
Amputations
Complications
War related trauma
General Orthopaedics
Congenital and developmental problems
Bone tumours
Infection
Degenerative conditions
Trauma in Perspective
 

> CLAVICLE FRACTURES
> ACROMIAL-CLAVICULAR JOINT SEPARATION
> SHOULDER DISLOCATION
> PROXIMAL HUMERUS FRACTURES
> HUMERAL SHAFT FRACTURES
> SUPRACONDYLAR FRACTURES OF THE HUMERUS
> OLECRANON FRACTURES
> FRACTURES OF THE RADIAL HEAD AND NECK
> ELBOW DISLOCATION
> FOREARM FRACTURES
> DISTAL RADIUS FRACTURES
> CARPAL FRACTURES AND FRACTURE DISLOCATIONS





DISTAL RADIUS FRACTURES

Fractures of the distal radius occur with a fall on the outstretched hand. The direction of the deformity depends on the position of the wrist at the time of impact (Figure 18.28).

Figure 18.28
Figure 18.28


The goal of fracture treatment is to restore the normal anatomy of the following deformities:
l Shortening of the radius relative to the ulna (Figure 18.29)

Figure 18.29
Figure 18.29

:: Loss of the volar tilt of the radial articular surface, seen in the lateral X-ray (Figure 18.30)
Figure 18.30
Figure 18.30

:: Disruption of the articular surface.


Evaluation

:: Make the diagnosis based on the history of a fall on the outstretched hand, swelling and tenderness about the wrist and the presence of deformity
:: Evaluate tendon function, vascular supply and sensation in the hand
:: X-rays distinguish radius fractures from carpal injuries and determine if the fracture is adequately reduced.


Treatment

1 Anaesthetize for closed reduction, using general anaesthesia (ketamine), an intravenous lidocaine block or a haematoma block. A haematoma block involves placing 5–10 ml of 2% lidocaine directly into the fracture haematoma, using a strict aseptic technique (Figure 18.31).
Figure 18.31
Figure 18.31

2 Reduce the fracture by placing longitudinal traction across the wrist and applying pressure to the distal radial fragment to correct the angular deformity (Figure 18.32). For fractures that are dorsally angulated (Colle’s fractures), this is accomplished by wrist flexion and slight ulnar deviation.
Figure 18.32
Figure 18.32

3 Next, apply a sugar tong splint, moulded to maintain the fracture position. Three point moulding involves application of pressure above and below the fracture and counter pressure on the opposite side of the bone near the fracture apex.
4 Between 10 days and 2 weeks, change the sugar tong splint to a short arm cast and check the fracture position by X-ray. Healing takes about 6 weeks.
5 If a satisfactory position of the fracture fragments cannot be obtained or maintained, consider open reduction and internal fixation, placement of an external fixator or closed reduction with percutaneous pin fixation.

> CLAVICLE FRACTURES
> ACROMIAL-CLAVICULAR JOINT SEPARATION
> SHOULDER DISLOCATION
> PROXIMAL HUMERUS FRACTURES
> HUMERAL SHAFT FRACTURES
> SUPRACONDYLAR FRACTURES OF THE HUMERUS
> OLECRANON FRACTURES
> FRACTURES OF THE RADIAL HEAD AND NECK
> ELBOW DISLOCATION
> FOREARM FRACTURES
> DISTAL RADIUS FRACTURES
> CARPAL FRACTURES AND FRACTURE DISLOCATIONS



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  Kep Points  
The distal radius is one of the most common upper extremity fractures


Treatment is usually by closed reduction and application of a
U-shaped splint coaptation



 
The adequacy of the reduction can be judged by specific parameters visible on the post-reduction X-ray


 
The most common complication is malposition and loss of motion.