Makindo Medical Notes

A distal radius fracture is one of the most common orthopaedic injuries, usually caused by a fall on an outstretched hand (FOOSH) 🤚. The classic type is the Colle’s fracture → distal radial fracture with dorsal displacement, volar apex angulation, and extra-articular involvement. Other variants include Smith’s fracture (volar displacement), Barton’s fracture (intra-articular rim fracture), and die-punch fractures.

⚡ Mechanism of Injury

• Most commonly from a FOOSH during a fall, especially in elderly patients with osteoporosis. 🧓
• High-energy trauma (e.g. road traffic collisions 🚗, sports injuries 🏉) more common in younger adults.
• Direct trauma to the wrist may also cause this fracture.

🔎 Fracture Patterns

• Colle’s Fracture: Extra-articular, dorsal displacement, “dinner fork deformity” 🍴.
• Smith’s Fracture: Extra-articular, volar displacement, “garden spade deformity” 🛠️.
• Barton’s Fracture: Intra-articular rim fracture with dislocation of radiocarpal joint.
• Die-Punch: Depressed intra-articular fracture caused by axial load.

🩺 Clinical Presentation

• 👀 Deformity: “Dinner fork deformity” in Colle’s fracture; volar tilt in Smith’s.
• 🔥 Pain and swelling over distal radius.
• ✋ Limited movement and difficulty using wrist/hand.
• 🧠 Always assess neurovascular status: median nerve compression (thumb–middle finger numbness), radial pulse, and capillary refill.

👨‍⚕️ Examination

• Look for deformity, bruising, tenderness.
• Neurovascular exam:
  • 🧠 Sensation: Median nerve distribution (thumb, index, middle fingers).
  • ✊ Motor: Ability to flex/extend fingers and thumb.
  • ❤️ Circulation: Radial pulse, capillary refill.

📸 Imaging

• X-rays: Standard → AP, lateral, oblique.
  • Check for: dorsal displacement, loss of radial height, intra-articular involvement, comminution.
• CT Scan: Considered for complex intra-articular or highly comminuted fractures.

🛠️ Management

Depends on displacement, stability, and patient factors (age, bone quality, activity level).

• Non-operative:
  • For stable, minimally displaced fractures.
  • Haematoma block + closed reduction ➡️ restore radial length & tilt.
  • Immobilise with plaster cast (backslab → full cast). Cast quality (“3-point moulding” 🔑) determines stability.
• Operative:
  • Indications: unstable/displaced intra-articular, open fractures, failed closed reduction.
  • Options: ORIF with volar locking plate 🪛, external fixation, K-wires.

📊 Factors Affecting Reduction Success

• 🔄 Intra-articular vs Extra-articular: Intra-articular → higher risk of arthritis, needs anatomical reduction.
• 💥 Comminution: More difficult to reduce and less stable.
• 🧰 Cast technique: Poor moulding → redisplacement.

⚠️ Complications

• 📉 Malunion: Persistent deformity → pain, ↓ ROM, cosmetic issues.
• 🚫 Non-union: Rare, but risk increased with poor blood supply.
• 🧠 Median nerve injury: Carpal tunnel syndrome due to swelling/malalignment.
• 🦴 Post-traumatic osteoarthritis: Especially intra-articular fractures.
• ❄️ Stiffness/Complex Regional Pain Syndrome (CRPS): Particularly if rehab delayed.

✅ Conclusion

Distal radius fractures (especially Colle’s) are common after FOOSH injuries. Early recognition, reduction, and correct immobilisation are crucial to restore function. 🏥 Elderly osteoporotic patients are particularly at risk, while younger patients sustain more complex fractures. 👩‍⚕️ Proper follow-up with repeat imaging + physiotherapy ensures good long-term outcomes and reduces the risk of complications.