colles/smith/bartons/scaphoid fracture

1. Distal radial ulnar fracture/scaphoid #
Dr abdul rub
Attending consultant emergency department

2. Discussion
• ! Scaphoid fracture
• Colles fracture
• Smiths fracture
• Barton's fracture

3. Scaphoid Fractures
• 71% of all carpal bone fractures.
•aged 15-60 years.
•About 5-12% of scaphoid fractures are associated
with other fractures
•70-80% occur at the waist or mid-portion
•10-20% proximal pole

5. Physical examination

6. Physical examination
•Snuff box tenderness 100% sensitivity
•Scaphoid tubercle tenderness 20% specific
•Adding Scaphoid compression test :
Specificity reaches 74% (Parvizi et al)

7. Suggested by:
• patient’s age,
• mechanism of injury
• signs and symptoms
Imaging
• Xray….Can miss 20%of #
• CT Scan-for staging & if plain flims normal
• MRI-most sensitive test(within 24hrs with pain)
• Bone Scan (3-4days)-100% SENSITIVE

8. Wrist PA

11. Management of fractures
Most stable fractures can be treated with below
elbow thumb spica
Unstable fractures best treated with compression
screw fixation
• >1mm displacement
• Fragment angulation
• Abnormal carpal alignment

12. Closed treatment
•Stable non displaced fractures
•Short arm for 6-8 weeks in tubercle or distal
pole fractures
•Upto 12 weeks in waist fractures
•Position- wrist in neutral position
Nigel R.Clay, Joseph J.Dias, P.S. Costigan, P.J. Gregg, N.J. Barton. Need
The Thumb To be Immobilized In Scaphoid Fractures.

13. Complication$$
• Malunion
• AVN 15-30%

14. Distal radio-ulnar #
1. COLLES’ FRACTURE
2. SMITH’S FRACTURE
3. BARTON’S FRACTURE

15. • Osteoporotic bone
• Extra articular fracture-metaphysis involvement
• 2cm from radio carpel joint
• Look for styloid process# ulna

16. Other displacements (1/> displacements below occur in majority of the cases;
although in few cases it may be crack fracture without displacement)
oImpaction of fragments
oDorsal displacement
oDorsal tilt
oLateral displacement
oLateral tilt
oSupination

17. Clinical features:
oPain
oSwelling
oDeformity of the wrist
oOn examination;
 Tenderness
 Irregularity of the lower end of
radius
Radiological features: (Differentiated from
other fractures at the same site by looking at
the displacements)
oDorsal tilt can be detected on a lateral
X-ray:
 normal  faces ventrally
 dorsal tilt  faces dorsally or becomes
neutral
oLateral tilt can be detected on an AP X-
ray:
 normal  faces medially
 lateral tilt  faces laterally or becomes
horizontal

19. Treatment:
oUndisplaced fracture
immobilization in a below-elbow
plaster cast for 6 weeks
oDisplaced fracture manipulative
reduction followed by immobilization
in Colles’ cast

20. SMITH’S FRACTURE
• Fracture at the distal end of the radius,
at its cortico-cancellous junction, with
ventral tilt and other displacements
• Uncommon
• Treatment:
• Closed reduction
• Plaster cast immobilization (6 weeks)

22. BARTON’S FRACTURE
• Intra-articular fracture of the distal
radius
• Extends from the articular surface of the
radius to either its anterior/posterior
cortices
• The small distal fragments gets
displaced and carries with it, the carpals

23. • Displacements:
• Volar Barton’s fracture (anterior
type)
• Dorsal Barton’s fracture
(posterior type)
• Treatment:
• Closed manipulation
• ORIF with plate in cases where
closed reduction fails

24. Complications:
1.Stiffness of joints
2.Malunion
3.Subluxation of the inferior radio-ulnar joint
4.Carpal tunnel syndrome
5.Sudeck’s osteodystrophy
6.Rupture of the extensor pollicis longus tendon

26. Young guy /flextion hand fall

28. Hyperextension & fall

32. Questions?