Wrist Fxs

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Wrist Fxs
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Forearm
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Carpals
Proximal AScaphoid, BLunate, CTriquetrum
(Triangular), DPisiform Distal ETrapezium,
FTrapezoid, GCapitate, HHamate
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Volar Ligaments
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Dorsal Ligaments
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X-Ray

• Know the normal Anatomy

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The pediatric pt
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Suspected Fxs need 2 views
Lateral

• P/A

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Lateral View

• Discussion
• - view should demonstrate the metacarpals,
  lunate and radius aligned
• - hand will appear slightly palmar flexed

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P/A view
2mm

• On a correctly positioned PA view the extensor
  carpi ulnaris tendon groove (arrow) can be seen.
• The extensor carpi ulnaris tendon groove should
  be at the level of or radial to the base of the
  ulnar styloid.

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Describing wrist fxs

• Location?
• Extra- or intra- articular
• most important determinant of outcome
• articular step off (only with dislocation/fx)
• second most determinant of outcome
• - radial shortening
• radial tilt dorsal or volar?
• -angulation or inclination
• radialward or ulnarward

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Müller AO-classification
Adapted by the Orthopaedic Trauma Association
Colles

• A extra-articular fracture
• A1 ulna, radius intact
• A2 radius, simple and impacted
• A3 radius, multifragmentary

B partial articular fracture B1 radius,
sagittal B2 radius, frontal, dorsal rim
B3 radius, frontal, volar rim
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Müller AO-classification

• C complete articular fracture of radius
• C1 articular simple, metaphyseal simple
• C2 articular simple, metaphyseal
  multifragmentary
• C3 articular multifragmentary

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Describing wrist fxs

• Location?
• Extra- or intra- articular
• most important determinant of outcome
• articular step off (only with dislocation/fx)
• second most determinant of outcome
• - radial shortening
• radial tilt dorsal or volar?
• -angulation or inclination
• radialward or ulnarward

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What is articular step off?
The lunate bone dislocates, or steps off the
articular surface. Often seen in Barton
Fxs Cartilage damage. Doesnt heal
wellgtgtOsteophytes
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Describing wrist fxs

• Location?
• Extra- or intra- articular
• most important determinant of outcome
• articular step off (only with dislocation/fx)
• second most determinant of outcome
• - radial shortening
• radial tilt dorsal or volar?
• -angulation or inclination
• radialward or ulnarward

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Lateral view Radial Tilt

• Normal volar tilt average 11 (range of 2-20).
• Determining the tilt Angle between a line along
  the distal radial articular surface and the line
  perpendicular to the longitudinal axis of the
  radius at the joint margin.
• Significance If too increased cant set fx in a
  cast

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P/A view Radial Angle (inclination)
1
3
2

• Radial inclination or angle (Average 20 degrees)
• The angle between a line connecting the radial
  styloid tip and the ulnar aspect of the distal
  radius a 2nd line perpendicular to the
  longitudinal axis of the radius (start at distal
  RA joint).
• Loss of radial inclination will increase the load
  across the lunate.
• Cheat 2mm between the radius and lunate
• More Dislocation
• Less Impaction

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Fx Eponyms

• Fall on an outstretched hand
• Colles
• Smith
• Bartons
• Chauffers

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Colles Fx

• Hx Fall on an outstretched hand that is in
  extension.

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Colles Fx Displacement
Radial Tilt Dorsal Radial Length
Shortened Radial Angle Ulnar ward, Radialward or
none
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Colles Dinner Fork
The fracture almost always occurs about 1 inch
from the end of the bone.
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Fx?
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Smith Fx

• Hx Falling onto flexed wrists. Less common than
  Colles' fractures.

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Smith Fx Displacement
Radial Tilt displaced volarly (ventrally) Radial
Length Shortened Radial Angle Radialward,
Ulnarward or none
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Displacement?
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Bartons Fx
most common fx dislocation of the wrist joint

• Hx fall on an extended and pronated wrist
  increasing carpal compression force on the dorsal
  rim.

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Bartons Fx
Carpal displacement distinguishes this fracture
from a Smith's or a Colles' fracture
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2
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• 1. Dislocation of radiocarpal joint
• 2. may extend into the wrist joint
• 3. Often occurs along with a radial styloid fx
• Either anterior (volar) or posterior (dorsal)
  cortex

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Chauffeur's Fracture Radial Styloid Fractures

• Hx most commonly occur from ligament, tension
  forces sustained during ulnar deviation and
  supination of the wrist

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Chauffer Fx Displacement

• avulsed radial styloid
• - strong radiocarpal ligament
  (radioscaphocapitate)
• Frequently accompanied by dislocations of lunate

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Take Home

• AO-Classification
• Descriptive, somewhat prognostic
• Aextraarticular, Bpartial, CSOL
• A2Colles Fx
• Eponyms
• Colles Extension (Dinner Fork Deformity)
• Smith Flexion
• Bartons Dislocation along with Fx (looks like
  Colles and Smith)
• Chauffer Avulsion Fx (due to ulnarward deviation
  supination )