A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and. La fractura de Colles se caracteriza por una posición hacia atrás y hacia afuera de la mano en relación a la muñeca. Fractura de Colles. Learn more about Fractura de Colles at Virginia Complete Care for Women DefiniciónCausasFactores de riesgoSíntomasDiagnósticoTratamientoPrevenció.. .
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A distal radius fracturealso known as wrist fractureis a break of the part of the radius bone which is close to the wrist. In younger people, these fractures typically occur during sports or a motor vehicle collision. Treatment is with casting for six weeks or surgery. Distal radius fractures are common. People usually present with a history of falling on an outstretched hand and complaint of pain and swelling around the wrist, sometimes collee deformity around the wrist.
Any pain in the limb of the same side should also be investigated to exclude associated injuries to the same limb. Swelling, deformity, tenderness, and loss of wrist motion are normal features on examination of a person with a distal radius fracture. Reverse deformity is seen in volar angulation Smith’s fracture. The wrist may be radially deviated due to shortening of the radius bone.
Distal radius fracture – Wikipedia
Decreased sensation over the thenar eminence can be due to median nerve injury. Swelling and displacement can cause compression on the median nerve which results in acute carpal tunnel syndrome and requires prompt treatment. Collfs rarely, pressure on the muscle components of the hand or forearm is sufficient to create a compartment syndrome.
The most common cause of this type of fracture is a fall on an outstretched hand from standing height, although some fractures will be due to high-energy injury.
People who fall on the outstretched hand are usually fitter and have better reflexes when compared to those with elbow or humerus fractures.
The characteristics of distal radius fractures are influenced by the position of the hand at the time of impact, the type of surface at point of contact, the speed of the impact, and the strength of the bone. Distal radius fractures typically occur with the wrist bent back from 60 to 90 degrees. If the wrist is bent back less, then proximal forearm fracture would occur, but if the bending back is more, then the carpal bones fracture would occur.
With increased bending back, more force is required to produce a fracture.
More force is required to produce a fracture in males than females. Risk of injury increases in those with osteoporosis. Common injuries associated with distal radius fractures are interosseous intercarpal ligaments injuries, especially scapholunate 4. There is an increased risk of interosseous intercarpal injury if the ulnar variance the difference in height between the distal end of the ulna and the distal end of the radius is more than 2mm and there is fracture into the wrist joint.
Ulnar styloid process fracture increases the risk of TFCC injury by a factor of 5: However, it is unclear whether intercarpal ligaments and triangular fibrocartilage injuries are associated with long term pain and disability for those who are affected. Diagnosis may be evident clinically when the distal radius is deformed, but should be confirmed by X-ray.
The differential diagnosis includes scaphoid fractures and wrist dislocations, which can also co-exist with a distal radius fracture. Occasionally, fractures may not be seen on X-rays immediately after the injury. X-ray of the affected wrist is required if a fracture is suspected. Posteroanterior, lateral, and oblique views can be used together to describe the frsctura. A CT scan is often performed to further investigate the articular ve of the fracture, especially for fracture and displacement within the distal radio-ulnar joint.
Various kinds of information can be obtained from X-rays of the wrist: There are many classification systems for distal radius fracture. There are three major groups: A—extra-articular, B—partial collrs, and C—complete articular which can further subdivided into nine main groups and 27 subgroups depending on the degree of communication and direction of displacement.
However, none of the classification fracthra demonstrate good liability. A qualification modifier Q is used for associated colkes fracture. Correction should be undertaken if the wrist radiology falls outside the acceptable limits: Treatment options for distal radius fractures include nonoperative management, external fixation, and internal fixation.
Indications for each depend on a variety of factors such as the patient’s age, initial fracture displacement, and metaphyseal and articular alignment, with the ultimate goal to maximize strength and function in the affected upper extremity. Treatment is often directed to restore normal anatomy to avoid the possibility of malunion, which fracturs cause decreased strength in the hand and wrist.
Distal radius fractures are often associated with distal radial ulnar joint DRUJ injuries, and the American Academy of Orthopaedic Surgeons recommends that postreduction lateral wrist X-rays should be obtained in all patients with distal radius fractures in order to preclude DRUJ injuries or dislocations. The majority of distal radius fractures are treated with conservative nonoperative management, which involves immobilization through application of plaster or splint with or without closed reduction.
Variations in immobilization techniques involve the type of cast, position of immobilization, and the length of time required in the cast. For those with low demand, cast and splint can be applied for two weeks. In those who are young and active, if the fracture is not displaced, the patient can be followed up in one week.
If the fracture is still undisplaced, cast and splint can be applied for three weeks. If the fracture is displaced, then manipulative reduction or surgical stabilisation is required. Shorter immobilization is associated with better recovery when compared to prolonged immobilization. Therefore, follow up within the first week of fracture is important. Subsequent follow ups at two to three weeks are therefore also important.
Where the fracture is undisplaced and stable, nonoperative treatment involves immobilization. Initially, a backslab or a sugar tong splint is applied to allow swelling to expand and subsequently a cast is applied. However, an above-elbow cast may cause long-term rotational contracture.
However, neutral and dorsiflex position may not affect the stability of the fracture.
In displaced distal radius fracture, in those with low demands, the hand can be cast until the person feels comfortable. If the fracture affects the median nerveonly then is a reduction indicated.
If the post reduction radiology of the wrist is acceptable, then the person can come for follow up at one, two, or three weeks to look for any displacement of fractures during this period.
If the reduction is maintained, then the cast should continue for 4 to 6 weeks. If the fracture is displaced, surgical management is the proper treatment. Therefore, periodic reviews are important to prevent malunion of the displaced fractures. Closed reduction of a distal radius fracture involves first anesthetizing the affected area with a hematoma blockintravenous regional anesthesia Bier’s blocksedation or a general anesthesia.
The deformity is then reduced with appropriate closed manipulative depending on the type of deformity reductionafter which a splint or cast is placed and an X-ray is taken to ensure that the reduction was successful. The cast is usually maintained for about 6 weeks. Failure of nonoperative treatment leading to functional impairment and anatomic deformity is the largest risk associated with conservative management.
Prior studies have shown that the fracture often redisplaces to its original position even in a cast. In people over 60, functional impairment can last for more than 10 years. Despite these risks with nonoperative treatment, more recent systematic reviews suggest that when indicated, nonsurgical management in the elderly population may lead to similar functional outcomes as fracrura approaches.
In these studies, no significant differences in pain scores, grip strength, and range of motion in patients’ wrists occurred when comparing conservative fratura approaches with surgical management. Although the nonsurgical group exhibited greater anatomic misalignment such as radial deviation, and ulnar variance, these changes did not cilles to have significant impact on overall coloes and quality of life. The techniques of surgical management include open reduction internal fixation ORIFexternal fixationpercutaneous pinningor some combination of the above.
The choice of operative treatment is often determined by the type of fracture, which can be categorized broadly into three groups: Significant advances have been made in ORIF treatments. Two newer treatment are fragment-specific fixation and fixed-angle collex plating.
These attempt fixation rigid enough to allow almost immediate mobility, in an effort to minimize stiffness and improve ultimate function; no improved final outcome from early mobilization prior to 6 weeks after surgical fixation has been shown.
The alignment of the DRUJ is also important, as this can be a source of a pain and loss of rotation fratcura final healing and maximum recovery. An arthroscope can be used at the time of fixation to evaluate for soft-tissue injury. Structures at risk include the triangular fibrocartilage cractura and the scapholunate ligament. Scapholunate injuries in radial styloid fractures where fractra fracture line exits distally at the fracttura interval should be considered.
Prognosis varies depending on dozens of variables. If the fracttura bony alignment is not properly restored, function may remain poor even after healing. Restoration of bony alignment is not a guarantee of success, as soft tissue contributes significantly to the healing process. These fractures are the most common of the three groups mentioned above that require surgical management.
Manipulative reduction and immobilization were thought to be appropriate for metaphyseal unstable fractures. However, several studies suggest this approach is largely ineffective in patients with high functional demand, and in this case, more stable fixation techniques should be used. Surgical options have been shown to be successful in patients with unstable extra-articular or minimal articular distal radius fractures.
These options include percutaneous pinning, external fixation, and ORIF using plating. Patients with low functional demand dw their wrists can be treated fractuea with nonsurgical management; however, in more active and fit patients with fractures that are reducible by closed means, nonbridging external fixation is preferred, as it has less serious complications when compared to other surgical options. If the fractures are unlikely to be reduced by closed means, open reduction with internal plate fixation is preferred.
These fractures, although less common, often require surgery in active, healthy patients to address displacement of both the joint and the metaphysis. The two mainstays of treatment are bridging external fixation or ORIF. Percutaneous pinning is preferred to plating due to similar clinical and radiological outcomes, as well as lower costs, when compared to plating, despite increased risk of superficial infections. Impairment is the abnormal physical function, such as lack of forearm rotation.
It is measured clinically. Disability is the lack of ability to perform physical daily activities. Examples of scoring system based on clinical assessment are: These scores includes assessment of range of motiongrip strength, ability to perform activities of daily living, and colle picture.
fractura de Colles – English Translation – Word Magic Spanish-English Dictionary
However, none of the three scoring system demonstrated good reliability. These scoring systems measures the ability of a person to perform a task, pain score, presence of tingling and numbness, the effect on activities of daily living, and self-image. Both scoring systems show good reliability and validity.