Download as PDF, PPTX
Uploaded byAdam Watts
Intra-articular Dista Radius Fracture
The document discusses intra-articular distal radius fractures, their epidemiology, and treatment guidelines, focusing on factors that predict poor outcomes such as radial shortening, dorsal tilt, and intra-articular incongruity. It highlights the prevalence of associated injuries and the limitations of radiographic diagnoses, emphasizing the importance of thorough evaluation and potential surgical interventions. The findings reveal that while addressing articular fragments is crucial, volar locking plates may not resolve all complications associated with these fractures.
More Related Content
Similar to Intra-articular Dista Radius Fracture
Intra-articular Dista Radius Fracture
- 1. Intra-articular Distal Radius Fracture:plates/approaches Adam C Watts Consultant Elbow and Upper Limb Surgeon, Wrightington Hospital Visiting Professor Manchester University 1
- 2. www.wrightington.com Epidemiology 17.5% of allfractures Average age 55 yrs 69% in Women 76% as a result of a fall, <1% open OTA A 48% B 10% C 42% 2
- 3.
- 4. www.wrightington.com Guideline for treatmentand prognosis? Factors predictive of poor outcome radial shortening >3mm dorsal tilt > 12 degrees from normal carpal malalignment intra-articular incongruity 4
- 5. www.wrightington.com What is theeffect of radial shortening? 5
- 6. www.wrightington.com 6 Collaborators: Dr IsidroArche, Prof Teresa Rasgado What is the effect of dorsal tilt?
- 7. www.wrightington.com 7 Collaborators: Dr IsidroArche, Prof Teresa Rasgado
- 8. www.wrightington.com 8 What is theeffect of intra-articular step?
- 9.
- 10.
- 11.
- 12. Majima. J HandSurg 2008 www.wrightington.com 12 Neutral ExtensionNeutral Extension Majima J Hand Surg 2008
- 13.
- 14.
- 15.
- 16.
- 17.
- 18.
- 19.
- 20.
- 21.
- 22.
- 23.
- 24.
- 25.
- 26.
- 27.
- 28.
- 29.
- 30.
- 31.
- 32.
- 33.
- 34.
- 35. www.wrightington.com Associated Injuries Scapholunate ligament injury2 x more likely with intra-articular fractures only moderate inter- observer reliability for diagnosis from plain radiographs If there are no signs of SLD the risk of missing injury is 2% 35
- 36.
- 37. www.wrightington.com Arthroscopy and intra-articular distalradius fractures Up to 68% will have ligamentous injury 43% TFCC lesion 32% SLIL lesion 15% LTIL lesion Arthroscopic evaluation after ORIF will detect step >1mm in 33% Better reduction but no evidence for difference in PROM scores 37 Edwards, Charles C., et al. "Intra-articular distal radius fractures: arthroscopic assessment of radiographically assisted reduction." The Journal of hand surgery 26.6 (2001): 1036-1041. Geissler, William B., et al. "Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius." J Bone Joint Surg Am 78.3 (1996): 357-65. Ruch, David S., et al. "Arthroscopic reduction versus fluoroscopic reduction in the management of intra-articular distal radius fractures." Arthroscopy: The Journal of Arthroscopic & Related Surgery 20.3 (2004): 225-230. Doi, Kazuteru, et al. "Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation." J Bone Joint Surg Am 81.8 (1999): 1093-110.
- 38.
- 39. www.wrightington.com Outcome Minimum 5.5 yearsfollow up 76% had radiographic signs OA Significant association between residual displacement at union and arthrosis However function independent of residual displacement and arthritis 39
- 40. www.wrightington.com Intra-articular distal radius fractures Rebalancingcarpus will address most articular fragments Attention to die punch injuries and volar ulnar fragments Volar locking plates do not cure all! 40