1、 Fracture of Distal RadiusZhi-jie Xi, MDThe Department of trauma and Hand Surgery The First Affiliated Hospital of universityof Guangxi Traditional Chinese MedicineOutline Epidemiology Anatomy and biomechanics Radiographical and arthroscopic evaluation Classification Criteria for acceptable reductio
2、n predictors of instability Complication AAOS-guidelines DebatesEpidemiologyFrequency Distal radial fractures account for 1/6 of all fractures seen in the EDRaceNo racial preferences have been reportedAge Peaks at ages 5-14 years and at ages 60-69 years. Young patients intra-articular Elderly patien
3、ts extra-articularGender Postmenopausal women, female-to-male ratio 4:1 Adolescent boys and girls, the ratio is 3:1Anatomyvolar radial tuberositylunate facet buttressPQ = Pronator Quadratus Line, or PQ LineWS = Watershed Line,X = Volar Radial TuberosityVR = Volar Radial Ridge Biomechanics80% of the
4、load is taken on the distal radius and 20% of the load is taken on the TFCCDIC=dorsal intercarpal ligament DRC=dorsal radiocarpal ligamentRadiographic Assessment X-ray CT MRI Arthroscopic evaluation X-ray 0.9mm10-15正面切线位（ 11） 侧面切线位（ 21）标准侧位关节面切线位CTCTMRIArthroscopyClassification Fracture classificati
5、on systems are, in effect, tools. The purpose of the tool is to help the surgeon to choose an appropriate method of treatment for each and every fracture occurring in a particular anatomical region. The classification tool should not only suggest a method of treatment, it should also provide the sur
6、geon with a reasonably precise estimation of the outcome of that treatment.“-Albert H. Burstein, PhD, Deputy Editor for Research, Journal of Bone and Joint Surgery Colles fracture is an extraarticular low energy fracture primarily sustained in the elderly, a fracture almost unique to caucasian women
7、.a “classic“ Colles fractureSir Abraham Colles Fracture (1814)Smiths fracture 1847 Robert William Smith considered this “an injury of exceedingly rare occurrence,“ but its description heralded the age of vehicular trauma in 1847: The patient, in endeavouring to save himself from being run over by a
8、car, fell with great violence upon the back of his hand . . .Robert William Smith (1807-1873)woodcut from Smiths original description The classic Bartons fracture describes the dorsal rim fracture subluxation, a shear-type injury. John Rhea Bartons addresses the difference between a true dislocation
9、 and this fracture: a dislocation typically has no crepitus, and once reduced tends to remain that wayJohn Rhea Barton(1794-1871)Bartons Fracture (1838)Die punch “die punch“ fracture, or lunate load impact fracture of the posteromedial corner of the radius, was more recently described by ScheckThe absence of ligamentous attachments to the depressed fragment precludes reduction. In high energy trauma, one component of an unstable displaced fracture the axial load through the lunate creates an impact fracture on the lunate facet
