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
- 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.
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).
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.
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.
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.
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 ...