My Orthopedic Surgery

This paper is based on a presentation given at the AAOS Summer Institute, San Diego, September, 1996, and at the International Distal Radius Fracture Conference, San Francisco, May 8-10, 1998. The last literature citations were added on 12/30/99, and there have not been any changes in the thresholds for reduction in the literature up to May, 2006. The highlighted summary sections are still those advocated by most authorities.

The carpus, or wrist, is a complex joint that provides abduction and adduction in the frontal plane of the upper extremity, extension and flexion for hand movements, and supination and pronation in the coronal plane.
Synonyms and related keywords: wrist bone injuries, wrist injuries, wrist sprain, broken wrist, sprained wrist, wrist fracture, fractured wrist, forearm injury, carpus injuries, wrist dislocation, carpus dislocation, wrist joint, greenstick fracture, Colles fracture, Smith fracture, reverse Colles fracture, pseudocarpal injury, pseudo carpal injury, Galeazzi fracture, Monteggia fracture, dorsal dislocation, volar dislocation, distal radius fracture, scaphoid fracture, lunate fracture, traumatic carpal tunnel syndrome, CTS, carpal tunnel syndrome, perilunate dislocation, Hutchinson fracture
Author: Bryan Hoynak, MD 2007

Authors: L. Andrew Koman, M.D., Beth Paterson Smith, Ph.D., Thomas L. Smith, Ph.D.
Complex regional pain syndrome (CRPS), i.e., traditional reflex sympathetic dystrophy (RSD) or causalgia, is a frequent complicating factor following fracture of the distal radius with or without fracture of the ulna and may produce significant long-term sequelae.

Online surgery reference on distal radius (wrist) fractures. Includes classification, diagnosis, indications, preparation, approach, reduction and fixation, aftercare.

Update of Dr Nelson's eMedicine article
Synonyms
Colles' fracture, Pouteau's fracture, Smith fracture, volar Barton's fracture, chauffeur's fracture, broken wrist.
Distal radius fractures (DRFs) in the time of Hippocrates and Galen were thought to be wrist dislocations. Pouteau first varied from this tradition when he described a variety of forearm fractures in the French literature, including a DRF. As a result, DRFs are termed Pouteau fractures in the French-speaking world. However, politics and communications being what they were, the English-speaking world did not recognize the description.
The Irish surgeon Abraham Colles (pronounced "Collis") described DRFs in the 1814 volume of the Edinburgh Medical Surgical Journal. Colles based his descriptions on clinical examinations alone. Despite this limitation, his description of the fracture itself is quite accurate and his name is most often associated with this fracture in the English-speaking world. Colles stated "One consolation only remains, that the limb will at some remote period again enjoy perfect freedom in all of its motions and be completely exempt from pain..." This claim that all DRFs, despite displacement, fare well has been a source of criticism. Illustrated full text article with key references

Distal radius fractures account for approximately 15% of all fractures in adults. A thorough understanding of the pathophysiology and treatment of distal radius fractures is important because these injuries are not limited to just the elderly population. High-energy trauma to the distal radius in younger adults is becoming more prevalent, and long-term functional results are unclear. With an aging patient population that is increasingly active, these common injuries must be evaluated thoroughly and treated adequately.
Synonyms and related keywords: arm fracture, broken arm, distal radius fracture, distal radial fracture, dorsally displaced distal radius fracture, FOOSH, radial styloid fractures, Melone classification system, Melone fracture
Nana & Lichtman 2007

This site is an academic site devoted to studying distal radius fractures and is open to all surgeons. The goal of the site is to present a comprehensive inventory of distal radius fracture management information and resources, as well as up-to-date analysis of actual cases by internationally recognized experts.

It is estimated that one-sixth of all fractures evaluated and treated in emergency rooms are fractures of the distal end of the radius. Although most do well, some fractures result in permanent impairment and all create significant patient inconvenience. This chapter reviews the major classfication systems, diagnosis, and treatment options of distal radius fractures, including extensive and detailed operative techniques.
Authors - L. Andrew Koman, M.D., Beth Paterson Smith, Ph.D., and Thomas L. Smith, Ph.D.

A Report by the IFSSH BONE AND JOINT COMMITTEE.
The IFSSH Board of Directors wished to examine the potential for a universal classification of fractures and dislocations of the hand and wrist. If this could be accomplished, classifications could be standardized as a constant. The method of treatment would then be the variable. Scientific method would then be applied to analyze different outcome parameters. This would allow a comparative assessment of treatment methods between two or more groups throughout the world. It would allow the accumulation of data by the addition of related series of cases. This would add power to the validity of the conclusions reached by statistical analysis.
Our charge was to initiate the classification process in the targeted area of distal radial fractures. We were asked to examine existing classifications and select one, or modify, combine, or otherwise formulate and endorse a classification system for distal radial fractures. The classification system selected must be sufficiently simple so that it could be applied in undeveloped countries, and yet allow for the contribution of sophisticated analytical technology where it exists. It must provide intra-observer and inter-observer reliability. It should serve as a discriminator for treatment and outcome expectations.

The wrist is the most commonly injured region of the upper extremity. Fractures of the distal radius and ulna account for three fourths of wrist injuries. The carpal bones themselves are injured much less frequently but account for up to 10% of injuries to the structures of the hand. Not only are these injuries frequently encountered in the emergency department setting, but the mobility and delicate functional requirements of the hand make accurate diagnosis and treatment crucial to avoiding long-term loss of function and disability.
Synonyms and related keywords: fractured wrist, broken wrist, carpal bone fracture, distal radius fractures, ulna fractures, ulnar fractures, wrist fracture, scaphoid fracture, lunate fracture, triquetrum fracture, capitate fracture, hamate fracture, trapezium fracture, trapezoid fracture, pisiform fracture, lunate and perilunate dislocation, extension injuries, flexion injuries, fractures of the distal radius and/or ulna, extension fractures of the distal radius, Colles fracture, pseudocarpal injuries, wrist articular injuries, Barton fracture, push-off fracture, radial styloid fracture, Hutchinson fracture
Hoynak & Hopson 2007