Icd 10 distal radius fracture3/1/2024 Consider Osteoporosis evaluation and management.Brachioradialis is elevated and later closed over the plate. Radial Styoid fracture: can be approached via the first dorsal extensor compartment, identify radial nerve, Dissection and plate application procedes between the dorsal and palmar branches.12-16 hole 3.5mm plate is needed +/- bone graft. Spanning internal fixation: high-energy fx’s with proximal extension of at least 4cm may be treated with distraction 3.5mm ASIF Synthes plate similar to wrist fusion with screws in 3 rd metacarpal and proximal radial shaft. Closed reduction with well molded cast/splint Involvement of >50% of the diameter of the metaphysic as seen on any radiograph, comminution of at least 2 corticies of the metaphysic, or >2.0mm of shortening of the radius. AO Type C=complex articular high-energy, none of the articular surface remains in continuity with the metaphysic.AO Type B=partial articular fx of radial styloid, medial corner, die-punch fracture of central articular surface.AAOS Appropriate Use Criteria (AUC) on the Treatment of Distal Radius Fractures.Geriatric Patients (> 65) operative treatment does not lead to improved long-term patient reported outcomes.Non-Geriatric Patients (3mm, dorsal tilt >10 degrees, or intraarticular displacement or step off >2 mm leads to improved radiographic and patient reported outcomes.(AAOS Clinical Practice Guideline, 2011)ĭistal RadiusFractureFx Classification/Treatment 3mm, dorsal tilt >10º, intra-articular displacement or step-off >2mm.Essential radiographic evaluation for distal radius fractures. Malreduction of the volar ulnar corner leads to volar subluxation of the lunate and the development of posttraumatic arthritis. Teardrop of the distal radius: volar ulnar corner of the distal radius.CT (3-dimensional) improves recongnition of articular comminution and may aid in pre-operative planning (Harness NG, JBJS 2006 88A:1315).MRI if TFCC or scapholunate ligment tears suspected.1mm-2mm sagital CT best to view articular depression fx.Signs of DRUJ injury: fracture at the base of the ulnar styloid, widening of the DRUJ space seen on the P/A xray, >20° of dorsal radial angulation, and >5 mm of proximal displacement of the distal part of the radius.And measure the distance to the tip of the radial styloid. Draw a line perpendicular to the long axis of the radius intersecting the distal articular surface of the ulnar head. Radial length: best measured on true PA radiographs of both wrists for comparision.A/P widening on the lateral radiograph indicates articular surface displacement. Assess ulnar variance, carpal alignment and sigmoid notch conguence. Normal radiographic parameters: Radial inclination=23°,radial length=12mm, volar tilt=11°, scapholunate angle = 60° +/-15°. Pain and swelling in wrist generally after a fall onto the outstretched hand.Dorsal cutaneous branch of ulnar n arises deep to FCU, becomes SQ 5cm from pisiform-has multiple branchesĭistal Radius Fracture Clinical Evaluation.Palmar cutaneous branch of the Median nerve arises from the Median nerve proximal to the volar wrist crease and travels between the FCR and median nerve.Palmar branch passes within 2cm of 1st dorsal compartment provides sensation to dorsolateral thumb after passing directly over EPL. Sensory branch of radial nerve becomes subcutaneous 5-10cm proximal to radial styloid in interval between brachioradialis and ECRL.Radial inclination=23°,radial length=12mm, volar tilt=11°, ulnar variance -0.6mm, scapholunate angle = 60° +/-15°.Distal radius 3 column anatomy: Radial column (strong cortical bone), Intermediate column (contains lunate facet and sigmoid notch) Distal ulna column (contains TFCC) (Rikle DA, JBJS 1996 78Br:588).ROM-80°dorsiflexion, 85°palmarflexion, 90°pro\sup,25°radial deviation,35°ulnar deviation.Distal radius carries 80% of axial load.90% of distal radius fractures are Colles Fractures.90% caused by compression on dorsiflexed wrist.Distal Radius Fracture Etiology / Epidemiology / Natural History
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