Ver el código de «Distal radius fractures»

==Background==
{{Forearm anatomy}}
*Definition: Fracture at the metaphysis or the articulation of the distal radius
*One of the most common fractures seen in the ED (1/6th of all fractures treated)

{{Distal radius fracture DDX}}

==Clinical Features==
[[File:Dinner fork Deformity.jpg|thumb|Classic "dinner fork" deformity.]]
[[File:Distalradiusfracture.jpg|thumb|Distal radius fracture demonstrating the deformity in the wrist.]]
*Commonly from a fall on an outstretched wrist that is dorsiflexed
*Wrist/forearm trauma and pain
*Possible forearm deformity

===Exam Pearls===
*Perform full neurovascular assessment of the hand (including median, ulnar, and radial nerves
*Examine ipsilateral elbow, shoulder, and hand

==Differential Diagnosis==
{{Forarm fracture DDX}}

==Evaluation==
[[File:Collesfracture.jpg|thumb|[[Colles' fracture]], one type of distal radius fracture.]]
[[File:Radiograph_of_Barton's_fracture.jpg|thumb|Volar [[Barton's fracture]], one type of distal radius fracture.]]
[[File:Displaced distal radius fracture.jpg|thumb|Displaced, intra-articular distal radius fracture.]]
===Workup===
*Forearm x-ray AP and lateral

===Diagnosis===
*Typically from plain forearm x-rays

==Management==
{{General Fracture Management}}

===Acute Reduction===
*Indications: 
**Most angulated and/or displaced distal radius requires closed reduction and placement of a sugar-tong splint
**Consider even if operative management is expected (to reduce pain and swelling)
*Steps:
*#Adequate analgesia (e.g. [[morphine]] and/or [[hematoma block]])
*#highly consider [[procedural sedation]]
*#Axial traction: Manual or finger traps with hanging weights, if available
*#Recreate, then reverse, mechanism of injury
*#*Although recreating the injury briefly exaggerates the existing deformity, this maneuver "unlocks" any periosteal sleeve folded into the fracture site (which can be critical in achieving reduction)
*#*Continue to maintain axial traction throughout manuver
*#*For example with a fracture with dorsally angulated fragments, establish axial traction, then slightly bending the dorsal fragment even more dorsally while maintain traction, then reverse pressure to reduce the distal fragment volarly and back out to length, all while maintaining traction.
*#[[Splint]]
*#Re-image
*Goal:
**Always target optimal (anatomic) fracture reduction
**Operative fixation is recommended for fractures with post-reduction<ref>AAOS OrthoGuidelines. Treatment of Distal Radius Fractures. http://www.orthoguidelines.org/topic?id=1003</ref>:
***Radial shortening > 3mm
***Dorsal tilt > 10°, or
***Intra-articular displacement or step-off > 2mm

===Splinting<ref>Olive View Medical Center Upper Arm Extremity Splint Recommendations 2022</ref>===
*Reduction performed
**[[Sugar tong splint]]
*Reduction not attempted or failed
**[[Volar short arm splint]]
***If severe pain with pronation/supination, then [[sugar tong splint]]

==Disposition==
*Most can be treated with orthopedic follow up within 1 week

===Admit===
*[[Open fracture]]
*Neuro-vascular compromise
*Risk or concern for [[compartment syndrome]]
*Patient is unable to function at home (e.g. uses walker with that arm)

==See Also==
*[[Forearm fractures]]

==External Links==
*https://www.orthobullets.com/trauma/1027/distal-radius-fractures

==References==
<references/>

[[Category:Orthopedics]]