Distal Radial Fractures

Incidence

 

Metaphyseal > physeal / SH2

 

Aetiology

 

FOOSH

 

Operative Management

 

Indications

 

Visible deformity

> 20^o angulation

 

Options

 

MUA

MUA + K wire stabilisation

 

Indications K wire

 

Remanipulation of metaphyseal fracture

Instability

Associated with supracondylar fracture

 

Technique

 

Avoid physis if able in metaphyseal fracture

- dorsal Kapaji technique

- can use this technique laterally

 

Mercer Rang Remodelling Rules

 

Best if

- young age (won't remodel much if > 11 years)

- short distance from fracture to physis

- direction of angulation in plane of motion of joint

 

Won't correct rotation

 

Rang distal radius remodelling

- < 5      - 25-35° 

- 4 - 9    - 20-25

- 10-12   - < 15°

 

Rotational malalignment 

- best way to determine proximally is radial tuberosity 

- prominent towards the ulna with supination and disappears with pronation

- at same time radial styloid distal will be prominent with supination

 

Remanipulation

 

Never for physeal injuries

Up to 3/52 for metaphyseal injuries

 

Complications

 

Growth arrest

 

SHII DR

- around 1%

- need to warn parents to represent if child develops angular deformity

 

Do not MUA or repeat MUA after 1 week

- only reinjure growth plate

- will remodel extremely well

- if severe, simply plan for osteotomy later if required

 

Physeal injuries distal ulna

- high incidence of growth arrest

 

Metaphyseal Radius

- incidence growth arrest also 1%