Distal Radius Fracture

• Most common orthopaedic injury

• Osteoporosis is a risk factor

• Usually a fall onto outstretched hand (FOOSH)

• Xray imaging is essential to evaluate the fracture. CT scan is indicated in complex articular fracture.

• Many types exist

  • Colle’s fracture: dorsally displaced, extra-articular

  • Smith’s fracture: volarly displaced, extra-articular

  • Chauffer’s fracture: Radial styloid fracture

  • Die-punch fracture: depressed fracture of the lunate fossa of the articular surface of the distal radius

  • Barton’s fracture: Fracture-dislocation of radiocarpal joint with intra-articular fx involving the volar or dorsal lip

Treatment

• Cast: for nondisplaced fractures

• Percutaneous pinning (Kapandji) : for extra articular fractures, displaced dorsally, with an intact volar cortical bone

• Plate : for all other cases

• External fixator :

  • For epiphyseal communitive fracture

  • bad skin condition

  • damage control

Scaphoid fracture

• Scaphoid is most frequently fractured carpal bone

• Generally secondary to a fall onto outstretched hand (FOOSH)

• Incidence of fracture by location

  • waist -65%

  • proximal third - 25%

  • distal third - 10%

• Scaphoid’s vascularisation is essentially dorsal (branch of dorsal artery), supplying proximal 80% of scaphoid via retrograde blood flow. The remaining distal 20% is assured by palmar vessel branch.

• proximal fractures are more prone to necrosis ( or non union)

• Xrays should be obtain (with a scaphoid view: 30 degree wrist extension, 20 degree ulnar deviation)

• CT scan and MRI can rule out infra-radiologic fractures

Treatment

Metacarpe and Phalynx fracture

• Treatment based on which metacarpal is involved and location of fracture

• Acceptable angulation varies by location

• No degree of malrotation is acceptable

• For non displaced fractures, immobilisation in intrinsic position is advised.

• Percutaneous pinning or ORIF (screw/plate) are used for surgical interventions