hand
Distal Radius Fracture
intermediate
6 min
28 marks
6 questions
Clinical Scenario
A 58-year-old right-hand dominant female presents to ED 2 hours after falling onto an outstretched hand while walking her dog. She has immediate pain, swelling, and deformity of the right wrist. She has well-controlled type 2 diabetes and osteopenia on recent DEXA. On examination, there is a dinner fork deformity, dorsal swelling, and tenderness. She has intact radial pulse and normal finger sensation and movement.
PA and lateral wrist radiographs of a 58-year-old female showing a dorsally displaced distal radius fracture. Key measurements: dorsal tilt 25° (normal 11° volar), radial inclination 12° (normal 22°), radial height 8mm (normal 12mm), positive ulnar variance. Intra-articular step-off of 2mm is visible. This represents an unstable fracture pattern requiring surgical fixation.
Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License
Questions
Question 1 (4 marks)
Describe the normal radiographic parameters of the distal radius and criteria for instability.
Question 2 (5 marks)
Classify distal radius fractures using the Frykman and AO systems.
Question 3 (6 marks)
Describe the surgical technique for volar locking plate fixation.
Question 4 (5 marks)
What are the associated injuries and how do you assess for them?
Question 5 (4 marks)
What are the complications of distal radius fractures and their management?
Question 6 (4 marks)
Discuss the treatment of distal radius fractures in the elderly.
Exam Day Cheat Sheet
Must Mention
- •Normal: inclination 22°, height 12mm, volar tilt 11°
- •Instability: dorsal tilt >10°, shortening >5mm, step >2mm
- •Volar plate: proximal to watershed line
- •Check DRUJ stability intra-op
- •EPL rupture = attritional, EIP transfer
- •DRAFFT: no difference plate vs K-wire
Common Pitfalls
- •Wrong normal values
- •Missing DRUJ check
- •Forgetting EPL
- •Not knowing trials
- •Missing watershed line
- •Wrong classification