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Understanding Distal Radius Fractures: Importance of Imaging and careful Planning

This article explores the importance of understanding fracture patterns and utilizing 3D CT scans for accurate diagnosis and planning in distal radius fractures. It provides insights into various fracture parameters and their implications on treatment outcomes. The article emphasizes the significance of proper interpretation of radiographs and the limitations of traditional volar plates in certain cases.

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Understanding Distal Radius Fractures: Importance of Imaging and careful Planning

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  1. Slow Down Boys, You Better Get the 3D CT and Plan CarefullyThen Make a Decision Lisa L. Lattanza, MD Professor and Vice Chair Department of Orthopaedic Surgery Chief Hand, Elbow and Upper Extremity Surgery UCSF Medical Center

  2. UNDERSTAND THE FRACTURE PATTERN

  3. IMAGING

  4. Volar Tilt • Teardrop Angle • A-P distance • PA View landmarks

  5. Volar TiltLateral View • Normally about 10˚ • > 10˚ consistent with Volar Barton’s Fracture • Suggestive of an intra-articular fracture component Ω see Medoff, RJ. Hand Clinic 2005

  6. teardrop angle Teardrop AngleLateral View • Normally about 70˚ • Depression of teardrop angle suggests • residual dorsiflexion of a volar rim fragment • articular surface incongruity see Medoff, RJ. Hand Clinic 2005

  7. A-P DistanceLateral View • Normally about 18-20 mm • Normally about 1:1 ratio • Elongated A-P distance consistent with • discontinuity between volar and dorsal rims • discontinuity across the sigmoid notch • DRUJ instability see Medoff, RJ. Hand Clinic 2005

  8. Lunate Facet/Sigmoid Notch FracturesImplications and Significance • DRUJ instability • Articular surface incongruity • Carpal instability and displacement (alignment of the carpus relative to the distal radius is the most important predictor of function) Nana, AD et al. JAAOS 2005; Chen & Jupiter JBJS 2007

  9. WHY ARE THEY TROUBLESOME? • WHAT DO THE RADIOGRAPHS SHOW? INTERPRETATION IS KEY AND CAN BE DIFFICULT • FRAGMENTS CAN BE SMALL AND NOT AMENABLE TO TRADITIONAL VOLAR PLATES

  10. Evaluation • 2-D CT • More accurate than plain film x-rays in identifying: • Radio-carpal extension • Articular gap and step off • Comminution, metaphyseal defects • 3-D CT • Improved reliability determining: • articularcomminution • number of fragments

  11. CASE DK • 42 yo attorney • Fell on his dominant wrist playing basketball • No other injury • Otherwise healthy and active

  12. Cast? ORIF? Imaging? Or…. It’s a radius It must need a volar locking plate!!

  13. 86 yo male FOOSHOWH, Runs multi-millon dollar company

  14. dorsal volar

  15. DORSAL DORSAL

  16. NO COMMUNITY MINDED GUY THAT IS NOT GETTING A CAT SCAN TO UNDERSTAND THE FRACTURE • THESE ARE MOSTLY COMMUNITY MINDED PEOPLE • BY THE WAY LETS GO THROUGH THE LAST 4 TALKS WHICH ARE BULL SHIT • SO PICK ON EACH GUY TRY TO FIND THEIR PUBLICATIONS THAT REFUTES EACH TALK • OH XRY RIGHT INVENTED IN 1800 BY ROENTGEN…COME TO THE 21ST CENTURY

  17. SUMMARY • CT scan clearly gives better information than radiographs • Radiographs underestimate gap and articular surface depression • Even more important if medial facet involved • More important if not a hand surgeon but are treating distal radius fractures

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