Contents
Classification of distal radius fractures (at wrist level)
Wrist fractures can be classified according to the following criteria:
- Position
- Number of fragments
- Position of fracture ends
- intact stylus process of the ulna
- intact distal radioulnar joint
- Stability
- Accompanying injuries
- Bone condition
X-rays, one in the anterio-posterior and one in the lateral beam path, are part of the basic diagnosis; here there is a standard procedure with regard to the position of the wrist, beam distance, direction and X-ray technology. Each of the above criteria can be measured on the basis of these images.
If deemed necessary, the results may be supplemented by further specific investigations.
Position
The fractures can be divided into intra-articular and extra-articular fractures, i.e. with and without joint involvement. The intra-articular fractures can affect the radiocarpal joint, the spoke-elbow joint, or both joints.
Number of fragments
Fractures can occur as a single-fragment or debris fracture. Simple fractures can be transverse or oblique. The bevel is defined on the basis of the X-ray images. Frantumization can affect the extra-articular dorsal bone wall, the extra-articular palmar bone wall, the distal articular surface of the spoke, the radiocarpal joint or the distal spoke-elbow joint.
Position of fracture ends
Fractions can be undisplaced or displaced. If the displacement – regardless of the plane – is greater than 1 mm, it is called a displaced fracture.
Intact stylus process of the ulna
The X-rays provide information on whether the stylus process of the ulna is undamaged or not. The fracture can be at the top, bottom or center.
Intact distal radioulnar joint
The stability of the spoke-elbow joint far from the body must be examined both clinically and X-rayally.
You can perform a comparative examination with the uninjured side.
It must always be checked whether there are subluxations or displaced dorsal or palmar fractures.
Stability
Taking into account the clinical and radiological aspects, the following criteria are used to diagnose instability of the distal radius fracture:
- bone fragment angle greater than 10°;
- bone shortening greater than 5 mm;
- joint incongruity greater than 2 mm;
- Frantumization of the bone wall on the entire central axis line, visible on the lateral X-ray;
- rupture of the dorsal and palmar bone wall;
- irrepayable fracture;
- unavoidable loss of correction after setup.
Accompanying injuries
The accompanying injuries should be catalogued. Any cracks, bruises, tears of soft tissues must be taken into account, i.e. skin, muscles, tendons, nerves, ligaments, as well as displacement of the bone.
The cracks must be registered as incomplete or complete; Extent and direction shall be measured, as in the case of crushing and demolition.
In the case of ligament injuries of the wrist, the triangular interjoint disc must be evaluated and the inner and outer ligaments.
Bone condition
The bone density has an influence on the fracture shape, the displacement of the fracture ends, the cohesiability of the fragments and thus also on the prognosis.
Osteoporosis or osteopenia can be examined and evaluated by measuring bone density (e.g., using dual X-ray absorptiometry, DXA).
Among the spoke fractures near the wrist, there are two more common forms of fracture, which are characterized by the direction of the forces acting on the wrist during the fall:
1. Colles fracture is the most common spoke fracture of the wrist. The injury usually occurs during a fall on the wrist stretched upwards (extension fracture).
The impact causes a transverse fracture about 2-3 cm distal of the spoked joint surface.
The fracture ends are shifted towards the back of the hand, it may be a debris fracture.
The fragments are usually squeezed and fragmented in the dorsal area; the fracture can extend to the pineal gland and involve the radiocarpal joint or distal radioulnar joint.
Resnick has observed that in 50-60% of cases, Colles fractures occur together with a fracture of the stylus process of the ulna.
In case of a fracture of the ulnar stylus process, it is necessary to examine whether the interjoint disc is torn; This triangular fibrocartilage disc is attached to the edge of the incisura ulnaris and is intended to stabilize the distal spoke-elbow joint.
2. Smith fracture: caused by a fall on the wrist bent hand or hyperflexion or hypersupination trauma). Smith fracture can also be referred to as an inverse colles fracture because the distal fragment dislocates to the palm.
The displacement of the fragments leads to typical malpositions of the hand. The elbow can shift dorsal.
In addition to these two common types of fractures, there are numerous others. The methods of treatment depend on the form and severity of the fracture, as well as on the needs and state of health of the patient. The attending physician must weigh all aspects and create a satisfactory treatment concept.
Read more:
- spoke fracture, presentation
- spoke fracture, treatment
- spoke fracture, rehabilitation
- Spoke head fracture
