Distal radius fracture

Distal radius fractures are among the most common fractures seen in emergency departments. They occur in a bimodal pattern: high-energy injuries in the young and low-energy falls in older people with osteoporosis.

Classification

• Colles: dorsal angulation and displacement of the distal fragment
• Smith: volar angulation (a reverse Colles)
• Barton: intra-articular fracture–dislocation of the dorsal or volar rim
• Chauffeur: radial styloid fracture

Radiographic features

Plain radiograph

PA and lateral views are assessed for:

• Radial inclination (normally about 22°) and radial height (about 11 mm)
• Volar tilt on the lateral view (normally about 11°)
• Intra-articular extension and step-off
• Associated ulnar styloid fracture and distal radioulnar joint injury

CT

Helps plan surgery for comminuted intra-articular fractures.

Treatment and prognosis

Undisplaced or acceptably reduced fractures are treated in a cast. Unstable or intra-articular fractures may need K-wires or volar plate fixation. Older patients often do well functionally even with imperfect alignment.

Practical points

Always assess the scaphoid and the carpal alignment on wrist films; associated injuries are easy to miss.