Common Types Of Distal Radius Fractures - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the common types of distal radius wrist fractures.
Anatomy associated with distal radius fractures:
- Radioulnar joint.
- Sigmiid notch.
- Lunate fossa.
- Scaphoid fossa.
The most common types of the distal radius fractures:
- Colles fracture:
• the most common type,
• It is a distal radius fracture in the wrist, has a characteristic backwards displacement of the hand.
• It’s a low energy fracture, extra articular fracture with dorsal displacement of the distal fracture fragment.
• It typically occurs in patients more than 50 years old from attempting to break a fall with an outstretched hand.
• This fracture some times is referred to as “dinner fork” deformity, due to the shape of the fractured forearm.
• TFCC tears occurs in 50% of extra-articular distal radius fractures versus 1/3 of intra articular fractures.
• Dorsal comminution is frequent and if comminution is to 50% of the dorsal cortex, then treatment with a cast will not work. The more dorsal flexion, then the more comminution and more chance of fracture failure when using a cast.
• Colles fracture that extends to the DRUJ has a worse prognosis.
- Smith fracture:
• Is an extra articular transverse fracture that is palmarly displaced and can be thought of as a reverse Colles fracture.
• It could occur from a fall onto a flexed wrist.
• This fracture has multiple types:
1- Type I: fracture is extra articular transverse fracture through the distal radius (most common)
2- Type II: fracture crosses into the dorsal articular surface.
3- Type III: fracture enters the radiocarpal joint (volar barton fracture equals a Smith type III fracture), both will involve the intra- articular distal radius and includes possible dissociation of the carpal bones.
- Die- Punch fracture:
• Is a depressed fracture of the lunate fossa that results from axial loading forces on the distal radius that is transmitted through the lunate bone.
• It is intra- articular fractures of the lunate fossa of the distal radius.
• Check to see if there is any carpal bone dissociation.
- Bartons fracture:
• Intra articular fracture of the distal radius with dislocation of the radiocarpal joint.
• These fractures can be dorsal or volar.
• Check for carpal bone disruption or dissociation.
• It is caused by a fall on an extended and pronated wrist with the volar type being the most common type. The fracture fragment is usually smaller with the dorsal barton fracture.
• The volar barton fracture is the fracture of the volar margin of the of the distal radius, which is associated with subluxation of the radio-carpal joint.
• The most striking finding is subluxation or dislocation of the wrist with that small fragment.
• You can see in the picture the strong volar radiocarpal ligament avulses the volar lip of the radius.
• This fracture is very similler to the Smith type III fracture.
• Treatment of volar barton fracture is usually surgery with a volar approach and volar plate.
• Dorsal Barton: the dorsal shearing force, distal radius fracture with dislocation of the radiocarpal joint, fracture ia intra-articular and involves the dorsal lip.
Dislocation is the most striking x-ray finding. The avulsed fragment is usually small.
Treatment is open reduction internal fixation through a dorsal approach.
- Chauffer fracture:
• Is fracture of the radial styloid process in association with scapholunate dissociation.
• It is caused by compression of the scaphoid bone of the hand against the styloid process of the distal radius.
• Evaluation of the radial styloid fracture should always include supinated view x-rays so that scapholunate dissociation can be ruled out.
• Look for major swelling of the wrist and distal DISI deformity on lateral x-rays with a widening gap between the lunate and scphoid bones on AP view.
• DISI deformity: the scapholunate angle is usually about 47° and can be up to 60°, any angle that is greater than 60° is considered abnormal; this is usually seen with a DISI deformity due to the palmar flexion of the scaphoid. This means that there is scaphoid dissociation. The scaphoid and lunate bones turn in opposite directions.
• Treatment of this fracture is: compression screw fixation of the radial styloid process.
• Assess the scapholunate joint for possible stabilization.
In conclusion:
- During assessment of the x-rays, you need to see if there is any involvement of the dorsal or volar rim of the radius.
- Check for involvement of the DRUJ and look for die-punch lesions.
- Check for dislocation of the wrist and the direction of the displacement.
- Check the carpal distribution to see if there is any dissociation between the carpal bones.

[jewlen]

This is exactly the information I was looking for. Great presentation, thank you Dr. Nabil.

[chilukalasivanarasimharedd]

Mind blowing presentation. Thanks for all your effort.

[samirabdelfattahawaad]

I would like to thank you for the good presentation and informative videos
I'm happy to follow you
I will spread these videos to my department
Thank you again

[kukulidouce]

Thank you Dr. Ebraheim, you have really helped me to focus on my case with more logical explanation of why I can see, on the outside, and after cast was placed on my left forearm and left wrist, an obvious anatomical distortion of both bones and displacement.

It is difficult for me to see from your very illustrative and clear video, if you are talking about the left or the right arm. Or I am failing to see the obvious. Anyway, I am in the process of gathering information about what could have gone wrong to cause this deformity and displacement of the Ulna, if that is the bone sticking out on the outside of my left forearm and wrist.

The explanation given was that the bone facing the interior of the left arm, had shortened and, therefore, the bone facing the outside was sticking out.

Wish I could talk to you... You sound clear and precise in your explanation and I picture you as a gentle intelligent doctor. My father was a doctor, an obstetrician and he was like that. Clear, precise, logical, amiable and full of knowledge which showed he knew what he was talking about and he would take care of anyone in a thoughtful way...

I love you...!!! Take care... I am 80 years old, with osteoporosis, prone to falls and what happened really has taken a toll of me. Used to play the piano, guitar and organ; passionate about baking and cooking and I do hope I can do all those things again after the recouping period is over...

[richardhero]

the mine was the colles fracture in both hands and arm, after a car auto hit me from my back when I was riding my bicicle! some weeks ago, uh so painfull, two surgeries I have actually one in each hand, thanks god I feel a little better now!

[noofalhussini]

I Am GP ..I hope to be orthopedic doc..you made me falling in love for orthopedic ...from yemen 😍❤

[geoffreykibuga]

Thank you for the presentation.I find it very useful for clinical care of patients

[rizamaymendijar]

helped me so much in my Surgery exam
thank you, doc!

[lwingyi]

Thank you so much for sharing valuable topics

[abubakarbajwa]

Beautifully explained.Excellent pictorial evidence

[Creative-Chaos]

Thank you. I’m headed to the orthopedic surgeon tomorrow knowing that I will be needing surgery. This video at least gives me a conversation point to understand what he’s saying.

[blingblingmystar]

Thank you doctor this helped me very much you have amazing pictures to show

[kiranlsudambils]

Chauffer fracture is it possible to treat without surgery ?

[choppy]

“sprained” my wrist about a month and a half ago roller skating. i landed with my arm parallel to the ground, and my wrist wasn’t bent. my whole body weight landed on my wrist, pinky touching the ground while my thumb would be up in the air. i feel like it’s actually fractured, very slightly though because it really hurts but i can still have some movement. the walk in doctor said nothing is wrong though

[alafrosty]

At 2:09, you omitted descriptions of what "TFCC" and "DRUJ" stand for and their locations.

[coolmedico]

Very good learning platform. ..thank you

[archikogan]

i have to say u have best view of orthopedic and trauma

[fatiaden]

Thanks alot, Allah merce you, you teach me something that I confused👍💖

[samuelt]

Thank you for the presentation, I think I need to go a proper orthopedic to check my Wrist which I am treating Locally after a fall from a 12ft high ladder since 2 months into treatment I'm not still able to make a fist.

[shamakuma]

Barton's is intra articular fracture of base of first metacarpal. That's what I think.