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A 78-year-old woman presents with wrist pain after falling on her outstretched arm. There is a dorsally displaced deformity at the area of tenderness (Figure 1). Distal neurovascular function is intact.

  • What is this fracture called?
  • How is it managed?

Hint: There is an eponym associated with this fracture (name of the person credited with the initial description of the injury).

The nature of an extremity injury can often be predicted from the mechanism of injury, the age of the patient, and the findings on physical examination. A fall on an outstretched hand is a common mechanism causing wrist injury.

The patient’s age determines the weakest part of the extremity, i.e., the part most susceptible to fracture. In children, the growth plate and distal radial metaphysis are the weakest elements and so growth plate (Salter-Harris) fractures and metaphyseal torus (buckle) fractures are most common. In young adults, the distal radius is relatively strong, and so scaphoid fractures and other carpal injuries are more likely. In the elderly with osteoporosis, the distal radius is again the most vulnerable part.

Distal Radius Fractures

A number of eponyms are associated with common fractures of the distal radius: Colles, Smith, Barton, and Hutchinson (“chauffeur’s” or “back-fire” fracture) (Figures 3, 4, 5, and 6).

Figure 2

Colles fracture.

A fracture through the distal radial metaphysis with dorsal displacement. There is extension of the fracture into the radiocarpal joint as well as a fracture of the ulnar styloid.

Figure 3

Excerpt from Colles’ 1814 paper describing the difficulty in determining whether the injury is a fracture or dislocation. Earlier authors had believed it was a dislocation.

Figure 4

Smith fracture.

A distal radius fracture with volar displacement. The mechanism of injury is either a blow to the dorsum of the wrist or a fall onto an outstretched supinated hand.

Figure 5

Volar Barton fracture.

A fracture of the volar rim of the distal radius with subluxation of the radiocarpal joint (arrow). The dorsal cortex of the distal radius is intact. The pronator quadratus ...

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