Các loại gãy xa xương quay đặc biệt (Radius, Distal Fractures)

Colles fracture In 1813, Abraham Colles described the Colles fracture, which is reported to be the most common distal radial fracture. The injury is usually produced by a fall onto an outstretched hand (FOOSH) mechanism with the wrist in dorsiflexion. The impact produces a transverse fracture in the distal 2-3 cm of the radial articular surface. The fracture is dorsally displaced and may be comminuted. The fracture pattern is often described as a silver or dinner-fork deformity. The fracture fragments are usually impacted and comminuted along the dorsal aspect; the fracture can extend into the epiphysis to involve the...
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Các loại gãy xa xương quay đặc biệt (Radius, Distal Fractures) Các loại gãy xa xương quay đặc biệt (Radius, Distal Fractures)Colles fractureIn 1813, Abraham Colles described the Colles fracture, which is reported to be themost common distal radial fracture. The injury is usually produced by a fall ontoan outstretched hand (FOOSH) mechanism with the wrist in dorsiflexion. Theimpact produces a transverse fracture in the distal 2-3 cm of the radial articularsurface. The fracture is dorsally displaced and may be comminuted. The fracturepattern is often described as a silver or dinner-fork deformity. The fracturefragments are usually impacted and comminuted along the dorsal aspect; thefracture can extend into the epiphysis to involve the distal radiocarpal joint or thedistal radioulnar joint.Resnick noted that 50-60% of Colles fracture cases are associated with an ulnarstyloid fracture.An associated ulnar styloid fracture should prompt an investigationfor tears of the TFC. The TFC extends from the rim of the sigmoid notch of theradius to the ulnar styloid and is thought to stabilize the distal radioulnar jointAO Classification of Colles FracturesA Extra-articularB Partial articularC Complete articular1 Simple articular and metaphyseal fracture2 Simple articular with complex metaphyseal fracture3 Complex articular and metaphyseal fractureSmith fractureRobert Smith described the Smith fracture in 1847. An impact to the dorsum of thehand or a hyperflexion or hypersupination injury is thought to be the cause. ASmith fracture is usually called a reverse Colles fracture because the distalfragment is displaced volarly. It is often described as a garden-spade deformity.The ulnar head can be displaced dorsallyThomas Classification of Smith FracturesI Most stable, extra-articular, transverse distal radial fracture with palmar andproximal displacementII Barton type, palmar-lip fracture of the distal radius with dislocation of thecarpusIII Unstable, oblique, juxta-articular fracture of the distal radius and tilted palmarBarton fractureJohn Rhea Barton characterized the Barton fracture in 1838.This fracture involvesa dorsal rim injury of the distal portion of the radiu s. The volar Barton fracture isthought to occur with the same mechanism as the Smith fracture, with more forceand loading on the wrist. The dorsal Barton fracture is caused by a fall on anextended and pronated wrist, increasing carpal compression force on the dorsalrim. The salient feature is a subluxation of the wrist in this die -punch injury.The Barton fracture involves either the palmar or dorsal radial rim, and themechanism is intra-articular. By definition, this fracture has some degree of carpaldisplacement, which distinguishes it from a Colles or Smith fracture. The palmarvariety is more common than the dorsal typeHutchinson, chauffeurs, or radial styloid fractureThe chauffeurs fracture derives its name from injuries that were acquired, in thedays when motor vehicles were cranked, when a vehicle backfired. The force isdescribed as a direct axial compression of the scaphoid into the radial facet. Theradial styloid is fractured, with associated avulsion of the radial collateralligament. A chauffeurs fracture represents an avulsion related to the attachmentsites of the radiocarpal ligaments or of the radial collateral ligament. Scapholunatedissociation and lesser arc injuries of the wrist may be indicated by a fracture lineon the radial articular surface between the scaphoid and lunate fossae.The PA view usually demonstrates the lesion. Wood and Berqu ist report that littleor no abnormality is seen on lateral views.Chauffeurs fractures are classified as simple or comminuted radial styloidfractures and as displaced or nondisplaced fractures. These injuries show noevidence of carpal subluxation.Complications include scapholunate dislocation, osteoarthritis, and ligamentousdamage.Galeazzi, or Piedmont, fractureA Galeazzi fracture results from a FOOSH mechanism with the forearmhyperpronated or from a direct impact to the dorsal radial wrist. The ra dialdiaphysis at the distal and middle third junction is fractured, with associatedsubluxation of the distal radioulnar joint. On PA views, the radius is shortened andthe radioulnar joint is disrupted.Radioulnar distances greater than 2 mm are suggesti ve of a ligamentous injuryand/or a tear of the TFC. On the lateral view, the distal radius is angulated eithervolarly or radially as a result of the pull of the brachioradialis muscle with morethan 3 mm of ulnar displacement. An associated ulnar styloid fracture also may bepresent.PA views may show a displaced radial and ulnar styloid. The lateral view mayreveal the associated radioulnar dislocation that is occult on the AP view.Classification is based on the direction of displacement of the distal f racturefragment.Complications include radial malunion, nonunion, and persistent subluxation ofthe radioulnar jointEssex-Lopresti fractureThe Essex-Lopresti fracture consists of a comminuted and displaced radial headfracture along with disruption of the distal radioulnar joint and interosseousmembrane. The thickened ridge of the scaphoid and lunate facets dissipates theenergy delivered to the wrist in a FOOSH injury and is thought to account forfractures that occur between the scaphoid and lunate fa cets of the radius. Thefracture line originates at the junction of the scaphoid and lunate fossae on theradial articular surface and courses laterally in a transverse or oblique direction.The intra-articular distal radial fracture of the radial styloid is associated with anavulsion of the radial collateral ligament.Routine PA and true lateral views are obtained. On the PA view, overlap,widening, ...