Distal Radius Fracture

       Fractures at the distal end of the radius are more common in adults and the elderly. The fracture occurs within 3cm of the distal end of the radius. The distal end of the radius is enlarged and composed of cancellous bone, and the junction of cancellous and compact bone is a weak point in stress. Fractures are more likely to occur here. The distal end of the radius forms the radius-ulna joint, and its articular surface tilts towards the palm side by 10° to 15° and towards the ulna side by 20° to 25°. When the fracture shifts, the angle of the articular surface changes, forming the common extension type fracture (Colles) and flexion type (Smith) fracture, the latter being less common.

　　1. Median nerve injury: When falling, the wrist joint is in a supinated and pronated position of the forearm, the palm is on the ground, and the force is concentrated on the spongy bone at the distal end of the radius, causing a fracture. The distal end of the fracture shifts to the dorsal and radial sides, stimulating the median nerve and causing injury.

　　2. Delayed rupture of the extensor pollicis longus tendon.

　　3. Fracture of the femoral neck.

1. After injury, there is significant swelling and pain above the wrist joint, local tenderness, and longitudinal axis patellar tenderness.
2. Displaced fractures have typical deformities, the distal end of the fracture in the extension type can appear a 'fork-like' deformity, and the radial displacement can appear a 'bayonet' deformity. The flexion type fracture shows the opposite deformity.

　　General measures to prevent the occurrence of fractures at the distal end of the radius are as follows:

　　To prevent the occurrence of fractures at the distal end of the radius, it is necessary to start with the causes of fractures; fractures at the distal end of the radius are caused by traumatic factors, including indirect and direct violence; however, indirect violence is more common; mostly when falling, the hand lands, and the force is transmitted upwards, resulting in fractures at the distal end of the radius. Therefore, paying attention to safety in production and life, avoiding trauma, and ensuring personal safety is the key to preventing this disease.

　　Elderly people are more prone to fractures due to osteoporosis, and they are more likely to suffer fractures when subjected to slight external force; moreover, the healing process of fractures in the elderly is slower, and the functional recovery is longer, so it is important for the elderly to monitor their bone density regularly, assess their bone density status, and seek timely medical treatment at a regular hospital to supplement calcium according to the doctor's instructions if the value is below the standard; they should also pay more attention to preventing falls and injuries in daily life when going up and down stairs or engaging in various activities; athletes are also a high-risk group for such fractures; if proper preparation or protective measures are not taken, it is easy to cause fractures at the distal end of the radius; therefore, athletes should take necessary protective measures before training; children who are just beginning to walk upright cannot maintain their balance well, and if protective measures are not taken properly, it can also lead to fractures at the distal end of the radius; therefore, parents of such children should provide more supervision and take necessary protective measures to prevent various fractures.

In the diagnosis of distal radius fractures, in addition to relying on clinical manifestations, auxiliary examinations are also needed. The main examination methods include the following several types:

1. X-ray imaging can clearly determine the type of fracture.
2. Laboratory examination shows an increase in white blood cells and neutrophils.

　　Appropriate diet for each stage of distal radius fractures:

　　In the early stage of fracture, due to the swelling and pain of the affected limb, as well as mental tension, patients often have no appetite and low appetite. Therefore, patients should drink more juice, congee, soy milk noodles, and eat some light and nutritious foods. Eat more foods rich in protein, vitamins, and fiber, such as lean meat, eggs, fish, soybeans, vegetables, and fruits.

　　In the middle stage of fracture, that is, 3-4 weeks after the fracture, it is the healing period of the fracture. Patients need a large amount of protein, especially foods rich in collagen, as well as foods high in calcium and vitamin D. It is appropriate to increase foods such as chicken soup, fish, eggs, pork skin, hog's feet, and soy products. For elderly fracture patients, it is necessary to supply vitamin D-rich and high-calcium foods such as beans, eggs, shrimp shells, kelp, milk, soybeans and their products, vegetables, potatoes, tremella, peanuts, etc.; the method of eating less but more often can be adopted.

　　In the late stage of fracture, that is, 5-6 weeks after the fracture, until the recovery stage, normal diet can be resumed, but it is still necessary to eat more fresh vegetables and fruits, as well as foods rich in calcium and vitamin D; drink 500 milliliters of milk every day, 400-500 grams of vegetables, and 200 grams or more of fruit; reasonably match other foods to achieve dietary balance and reasonable nutrition.

　　Prohibited foods for distal radius fractures:

　　(1) Avoid blind supplementation of calcium. Calcium is an important raw material for bone formation. Some people think that supplementing more calcium after a fracture can accelerate the healing of broken bones. However, scientific research has found that increasing calcium intake does not accelerate the healing of broken bones, and for fracture patients who have been lying in bed for a long time, there is a potential risk of increased blood calcium levels, accompanied by decreased blood phosphorus levels.

　　(2) Avoid eating too much pork bone. Some people believe that eating more pork bone after a fracture can promote early healing. However, this is not the case. Modern medicine has proven through multiple practices that eating more pork bone by fracture patients not only does not promote early healing but may also delay the healing time of the fracture.

　　(3) Avoid partial dieting. Fracture patients often have local edema, congestion, hemorrhage, and muscle tissue damage. The body itself has resistance and repair capabilities for these conditions. The raw materials for repairing tissues, forming bone callus, and resolving blood stasis and swelling depend on various nutrients. Therefore, ensuring a smooth fracture healing is primarily dependent on nutrition.

　　In summary, patients with distal radius fractures should pay attention to a balanced diet, avoid faddy eating, and avoid spicy, smoking, and alcohol.

　　For fractures without displacement or incomplete fractures at the distal end of the radius, no reduction is needed, and only the palmar and dorsal splints are fixed for 2-3 weeks; all displaced fractures can be treated with manual reduction and splint fixation. Manual treatment can be used for old fractures within one month. In order to facilitate the uniformity of reduction techniques and treatment, explanations are given according to the type of fracture.

　　1. Dorsal Fracture:

　　1. The method of reduction is to first release the impacted part under traction, then correct the radial displacement of the lower segment of the fracture, and then correct the palmar and dorsal displacement. The distal segment of the fracture, originally located on the dorsal side of the proximal fracture end, is reduced to the palmar side of the proximal fracture end. This is conducive to maintaining the reduction, especially for fractures with crushed cortical impaction on the dorsal side.

　　2. The methods of fixation include splint fixation, cast fixation, and needle fixation.

　　2. Smith Fracture (Flexion Type):The method of reduction and fixation is opposite to that of the dorsal fracture, and the forearm is fixed in a supinated position after reduction with a splint or cast. This type of fracture is unstable and should be checked frequently. For extremely unstable fractures, percutaneous pinning or plate internal fixation can be used instead.

　　3. Barton Fracture:Since this type of fracture is actually a variant of the dorsal fracture, the difference is only that the arc of the palmar side of the distal radius is normal, and the position of the styloid process does not change. In terms of treatment methods, it is basically the same as that of the dorsal fracture, and reduction can be performed under anesthesia, and the wrist can be fixed in a straight position or slightly palmar flexed position with a splint or cast. For unstable fractures, needle fixation can be used.

　　4. Reverse Barton Fracture:The treatment is opposite to that of Barton fracture in the method of reduction and fixation, and can be tractioned under anesthesia to slightly flex the wrist joint, while pushing the fracture block from the palmar side at the same time. After reduction, the wrist joint is fixed in a slightly flexed position for 4 weeks. If the reduction is unstable, open reduction and internal fixation can be performed.