Distal Radius Fracture
A 62 year old female presented after a fall onto an outstretched hand.
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
Extra-articular + ulnar styloid
Radio-carpal joint + ulnar styloid
Radio-ulnar joint + ulnar styloid
Radio-ulnar and Radio-carpal joint
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