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Distal End Radius Fractures - Colles, Smiths & Bartons
- 2. • Colles’ Fracture •Smith’s Fracture • Barton’s Fracture
- 3. • Described byAbraham Colles in 1814. • It is the most common of all fractures in elderly. • Usually in older women. • Fall on a out stretched hand.
- 4. Colles’ Fracture It isa Transverse fracture of the distal end of the radius at its Cortico-Cancellous Junction with typical Dorsal Displacement of the distal fragment.
- 5. • Distal endof the radius articulates with the carpal bones and the ulna • Normally the articular surface of radius faces ventrally and medially. • Tip of radial styloid is 1cm distal to the tip of the ulnar styloid. Relevant Anatomy
- 6. Mechanism of Action •History of fall on an outstretched hand • Force is applied in the length of the forearm with the wrist in extension • Fracture occurs transversely at the cortico-cancellous junction.
- 7. The distal fragmentcollapses into- • Dorsal Displacement • Dorsal Tilt • Lateral/Radial Displacement • Lateral/ Radial Tilt • Supination • Impaction of Fragments Also associated with extension and shortening.
- 8. Associated injuries • Fractureof styloid process of ulna • Rupture of the Ulnar collateral ligament • Rupture of the triangular Fibro-cartilage complex (TFCC) of ulna. • Rupture of the interosseos, radio-ulnar ligament causing radio-ulnar subluxation.
- 9. Clinical Features • Pain,tenderness, swelling and irregularity of the lower end of radius. • “Dinner Fork Deformity” • Radial styloid comes at the level of the ulnar styloid.
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- 11. Radiological findings • Transversefracture of the distal end radius at cortico- cancellous junction. • The distal fragment shows – a)Dorsal tilt & displacement – Lateral View b)Lateral tilt & Displacement – AP View • Maybe associated with communition or broken ulnar styloid process.
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- 14. Treatment Undisplaced Fractures Immobilization in below elbow plastercast for 6 week Displaced Fractures Closed Manipulation reduction followed by immobilization in Colles’ Cast Communited Fractures 1. Transfixed using two K- Wires within the plaster 2. External fixator 3. Locking compression plate
- 15. Closed reduction and manipulation •Under general or regional anesthesia. • “Shaking Hand Position” a.Firm longitudinal traction to disimpact. b.Distal fragment into palmar flexion and Ulnar deviation.
- 16. Colles’ Cast • Colles’Cast is used to immobilize undisplaced or reduced fracture. • It is below elbow cast with a.Palmar Flexion b.Ulnar Deviation a. b.
- 20. Complications Early • Circulatory Problems •Carpal tunnel syndrome – Median Nerve injury • Reflex sympathetic dystrophy • TFCC injury • Subluxation of inferior radio ulnar joint Late • Malunion • Delayed Union and Non-union • Stiffness • Extensor Pollicis Longus Tendon rupture
- 21. Smiths Fracture • Reverseof Colles’ Fracture • Ventral tilt and displacement of the Distal fragment
- 22. • Clinical features- “Garden Spade Deformity” • X-Ray – Ventral tilt and displacement • Treatment- Conservative - closed reduction and proper cast immobilization for 6 weeks. Surgical - K-wire or plate is used.
- 24. Barton’s Fracture • Intra-Articular fracture of distal radius. • Depending upon the type of displacement- a)Volar Barton’s (Anterior type) b)Dorsal Barton’s (Posterior type)
- 25. • Extends fromarticular surface of the radius to either its anterior and posterior cortices. • The small distal fragment is displaced along with the carpals. • Treatment a) Closed Reduction and Plaster Cast b) Internal Fixation by Plate or K-wire
- 26. Apley’s System of Orthopaedicsand Fractures – 9th edition Essential Orthopaedics – Maheshwari & Mhaskar – 5th edition