Distal radius fracture
| Distal radius fracture | |
|---|---|
| Classification and external resources | |
Colles fracture on X-ray
|
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| ICD-10 | S52.5 |
| AO | 21-A1 - 21-C3 |
| MeSH | S52.5 |
A distal radius fracture is a common bone fracture of the radius in the forearm. Because of its proximity to the wrist joint, this injury is often called a wrist fracture. Treatment is usually with immobilization, although surgery is sometimes needed for complex fractures.
Specific types of distal radius fractures are Colles' fracture; Smith's fracture; Barton's fracture; Chauffeur's fracture (so called because the crank used to start old cars often kicked back and broke the chauffeurs' wrists with a particular pattern). Most of these names are applied to specific patterns of distal radius fracture but confusion exists because "Colles' fracture" is used (for example by the US National Library of Medicine) as a generic term for distal radius fracture.
The most common cause of this type of fracture is a fall on an outstretched hand (acronym: FOOSH). In young adults this fracture is the result of moderate to severe force such as a fall from a significant height or a motor vehicle accident. The risk of injury is increased in patients with osteoporosis and other metabolic bone diseases.
Patients usually present with a history of an injury and localized pain. There is often a deformity in the wrist with associated swelling. Numbness of the hand can occur because of compression on the median nerve across the wrist (carpal tunnel syndrome). The wrist deformity often limits motion of the fingers.
Swelling, deformity, tenderness and loss of wrist motion are normal features on examination of a patient with a distal radius fracture. Examination should rule out a skin wound which might suggest an open fracture. It is imperative to check for loss of sensation, loss of circulation to the hand, and more proximal injuries to the forearm, elbow and shoulder. The most common associated neurological finding is decreased sensation over the thenar eminence due to associated median nerve injury.
The most commonly associated injury is to the ulnar styloid process. Styloid fractures can occur either to the very tip of the styloid or at the base. Because the triangular fibrocartilage (TFCC) attaches to the base of the ulna styloid, displaced fractures can result in instability of the distal radio-ulnar joint. Carpal bone fractures such as those to the scaphoid have been described, whereas instability or dislocations of the wrist are seen with certain types of distal radius and ulna fractures. Injuries to the elbow, humerus and shoulder are also common after a FOOSH (fall on outstretched hand). Swelling and displacement can cause compression on the median nerve across the wrist, an acute carpal tunnel syndrome. Very rarely is pressure on the muscle components of the hand or forearm sufficient to create a compartment syndrome.
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