![]() Typically higher inter/intraobserver reliability than most other systems. Priority should focus on stable versus unstable patterns that require fixation. Specific fracture-type eponyms are commonly utilized. ![]() Magnetic resonance imaging (MRI) studies-usually not necessary for most distal radius fractures but MRI can be useful in evaluating soft-tissue injuries including TFCC and scapholunate ligament injuries.Ĭlassification: Intraobserver and interobserver reliability is variable in most systems, so treatment indications based on classifications alone are difficult. A 45 degree pronated oblique view may help assess the dorsal ulnar cortex of the dorsal lunate fossa and the dorsal margin of the sigmoid notch.Ĭontralateral X-rays may help identify normal variant anatomy.įracture of the distal radius within 7.5 cm of the articular surface has been shown to be associated with a higher incidence of Galeazzi fracture and DRUJ injury.Ĭomputed tomography (CT) scans-although not always necessary, CT can be useful (after closed reduction) for assessment of intra-articular involvement and surgical planning purposes. If possible, obtain a zero-rotation posterior-anterior (PA) view, a lateral view, and a fossa lateral view. ![]() It is imperative that adequate wrist X-rays are obtained. Radiographs-these are mainstay in assessment of distal radius fractures. A volar accessory branch crosses over the flexor carpal radialis (FCR) at the wrist flexion crease. Radial artery runs along the side of the forearm in close proximity to the radial metaphysis. Ulnar nerve runs the length of the forearm deep to the flexor carpi ulnaris (FCU) muscle and tendon to just proximal to the wrist flexion crease where is passes into Guyon’s canal radial to the tendon and the pisiform. The median nerve runs volar to the distal radius with the profundus tendons between the two. The dorsal radiocarpal ligament is a potential deforming force in comminuted intra-articular fractures.Īnterior interosseous nerve (AIN) enters the pronator quadratus muscle proximally. Multiple extrinsic wrist ligaments stabilize the carpus. The radius and ulnar are strongly connected by the interosseous membrane ligaments. Deep ligaments run from the fovea of the ulna to the volar and dorsal rims of the sigmoid notch. The superficial ligaments attach to the ulnar styloid, which is often fractured with distal radius fractures. The triangular fibrocartilagenous complex (TFCC) stabilizes the DRUJ through superficial, and more important, deep ligaments. Pronator quadratus covers the volar distal surface of both the radius and ulna. It often acts as a deforming force in unstable fractures. ![]() The radial bow and DRUJ relationships are necessary for proper forearm rotation.īrachioradialis tendon inserts on the radial side of the styloid as the floor of the first dorsal compartment. ![]() 28.1 Articular facets of the distal radius. The radius bows laterally allowing for rotation around the straight ulna.Īrticular surfaces include scaphoid and lunate facets separated by an interfacet prominence (sagittal ridge), and the sigmoid notch as part of the distal radioulnar joint (DRUJ ▶ Fig. This includes fine sensation and carpal tunnel syndrome findings.Ĭomplete vascular examination is necessary but frequently normal. Thorough neurological examination of the median, ulnar, and radial nerves is imperative. Open fractures often include small skin lacerations that can be found on the ulnar wrist where the ulna styloid has penetrated through the skin.įunctional evaluation and point tenderness is noted on the entire extremity. The surgeon must ask about pain in the forearm, elbow, and shoulder.Īlways search entire extremity for signs of direct trauma, such as open wounds, bruising, or lacerations. Attempts must be made to quantify both the amount of energy transmitted through the distal radius as well as the direction of the force transmitted.Īssociated injuries more proximal to the distal radius should be assessed. The mechanism of injury dictates the degree of injury severity. ![]()
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