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

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

Evaluation

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
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
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.