Distal radius fractures

　　Fractures of the distal radius are very common, accounting for about 1/10 of all fractures. More common in elderly women, and in young and middle-aged adults, it is usually due to significant trauma. This disease can be divided into three types, with the etiology being:

　　1. Extension type fracture (Colles fracture)

　　The most common type, usually caused by indirect violence. Described in detail by A.Colles in 1814. When falling, the wrist joint is in extension and the forearm is supinated, with the palm on the ground. The force is concentrated on the cancellous bone of the distal end of the radius, causing a fracture. The distal end of the fracture moves towards the dorsal and radial sides. In children, it can be a growth plate separation; in the elderly, due to osteoporosis, even minor external force can cause a fracture, and it is often a comminuted fracture. The fracture ends are often shortened due to impaction. Comminuted fractures can involve the joint surface or be accompanied by a styloid process fracture of the ulna and dislocation of the distal radioulnar joint.

　　2. Flexion type fracture (Smith fracture)

　　Less common, first described by R.W.Smith in 1874. The cause of the fracture is opposite to that of the extension type fracture, hence also known as reverse Colles fracture. When falling, the back of the hand hits the ground, and the distal end of the fracture moves medially and ulnarly.

　　3. Barton fracture (Barton fracture)

　　It refers to a transverse oblique fracture of the distal radial joint surface, accompanied by carpal dislocation. First described by J.R.Barton in 1838. When falling, if the palm or back of the hand hits the ground, the force is transmitted upwards, causing a fracture of the radial joint surface through the impact of the distal carpal bones, forming a fragment of articular cartilage on the palmar or dorsal side of the distal end of the radius. The bone fragment often moves medially, and the wrist joint is dislocated or subluxated.

　　Distal radius fractures are very common, accounting for about 1/10 of all fractures. They are more common in elderly women, and young and middle-aged people occur due to greater external trauma. Fractures occur within 2-3cm of the distal radius. They often accompany damage to the radiocarpal joint and the ulnar carpal joint. This disease can lead to the following complications:

　　1, Malunion

　　Inaccurate reduction and unreliable fixation are the main causes of malunion of fractures. The extra-articular criteria for the treatment of distal radius fractures include the restoration of the metacarpal angle, radial obliquity, and height. The universally accepted standard is that the separation of the radiocarpal joint is less than 2mm, the dorsal tilt angle is less than 10 degrees, and the radial shortening is less than 5mm. Dorsal or palmar comminuted fractures, severe dorsal angulation or incomplete reduction are signs of possible recurrence and malunion after fracture fixation. Wrist dorsal deformity is mainly due to incomplete palmar flexion and ulnar deviation during reduction, leading to malunion. Wrist palmar deformity is due to excessive flexion during reduction, causing the distal end to deviate towards the palmar side without correction, especially in elderly patients with osteoporosis, which may be caused by excessive force during reduction. The recurrence rate of distal radius fracture reduction is high, especially in comminuted fractures, and it is more likely to occur during fixation and lead to malunion. Obvious deformities will seriously affect the function of the wrist joint.

　　2, Subscapularis joint dislocation

　　Subscapularis dislocation is most prone to occur in distal radius fractures and is easy to ignore. The subscapularis joint mainly relies on the joint disc and the radial carpal palmar and dorsal ligaments for stability. When the wrist is extended and falls, the ligaments may break, causing the subscapularis bone joint to dislocate. Early identification and treatment of subscapularis joint injuries associated with distal radius fractures are crucial for reducing the incidence of pain sequelae and functional impairment. X-ray examination shows that the subscapularis joint is greater than 3mm, indicating subscapularis joint dislocation. Accurate reduction and reliable fixation of the distal radius fracture can reduce the subscapularis joint dislocation and healing.

　　3, Median nerve entrapment

　　The position of reduction and fixation of the distal radius fracture causes the carpal tunnel to flex, the displacement of the fracture and the hematoma can increase the pressure inside the carpal tunnel, which may lead to median nerve compression and carpal tunnel syndrome in severe cases. After the reduction of the fracture, good alignment and alignment can be achieved, percutaneous pin fixation can reduce the incidence of median nerve entrapment, and early detection and early relief of median nerve entrapment can alleviate hand dysfunction.

　　4, Severe traumatic wrist arthritis

　　Maintaining the flatness of the joint surface is an important condition for the recovery of joint function in the distal radius fracture. For comminuted fractures, the most important criterion for successful treatment is the reconstruction within the joint, that is, the accuracy of the joint surface restoration. If the joint surface is uneven by more than 2mm, it is a indication for surgery. We adopt the method of levering reduction and pin fixation after puncture to treat the distal radius fractures involving the wrist or comminuted, which are extremely unstable, with good results.

　　5, Anterior forearm fascial compartment syndrome

　　Fixation of the掌屈尺偏加压, can cause the pressure in the anterior forearm fascial compartment to increase, excessive flexion of the wrist can reduce venous return, further increasing the pressure in the fascial compartment. In severe cases, fascial compartment syndrome may occur. Therefore, after the plaster or splint is fixed, observing the hand blood supply and the nature of pain can reveal the prodromes of fascial compartment syndrome, so that timely treatment can be carried out to avoid more serious complications.

　　The clinical manifestations of patients with distal radius fractures mainly include the following:

　　Wrist pain and swelling, especially limited by palmar flexion activity, in severe cases of fracture displacement, may appear a fork-like deformity, that is, the dorsal aspect of the wrist is prominent, the palmar aspect is prominent, the contour of the ulnar styloid process is invisible, the wrist is widened, the hand is displaced towards the radial side, the distal end of the ulna is prominent, the radial styloid process is elevated to or beyond the level of the ulnar styloid process, the distal end of the radius has tenderness, and the fracture end displaced towards the radial side can be palpated. In the case of comminuted fractures, bone grinding sounds can be felt.

　　This disease is caused by traumatic factors and has no special preventive measures. The focus of the prevention and treatment of this disease is to prevent the occurrence of complications, especially in the elderly. There are the following key points:

　　(1) Timely outpatient follow-up

　　The follow-up time is generally 1 time every 2 days in the first week, and 1 time per week after a week. First, check the tightness of the bandage and the swelling situation. Adjust the tightness of the splint bandage and the plaster splint according to the swelling of the wrist and forearm during the fixation. At 4 weeks, X-ray films show that the fracture has healed, and the fixation can be removed, and active functional exercise should be carried out.

　　(2) Preventing tendon and nerve injury

　　Generally, for Colles' fractures, the palmar flexion and ulnar deviation position is often used for fixation, which can increase the pressure inside the carpal tunnel. Some may compress the median nerve, and some may cause malunion of the fracture ends, plus long-term fixation, which can cause rupture of the extensor pollicis longus tendon. Attention should be paid during follow-up, and if discovered, timely surgical exploration and treatment should be performed.

　　(3) Early control of pronation displacement

　　During fixation, the affected limb should be kept in a supinated 15° position or a neutral position. Supination fixation often limits the supination function of the forearm, and it should be corrected in time and returned to the supinated position. Otherwise, it will affect the rotation function of the forearm.

　　(4) Early correct functional exercise

　　Patients should overcome their fear of pain and swelling due to functional exercise, and concerns about fracture and dislocation. Under accurate reduction and local firm external fixation, they should start the functional exercise of the affected limb as soon as possible. Start with passive movement, followed by active movement. The functional exercise should be progressive. On the day of fixation, finger joint movements, such as clenching and releasing the fist, can be performed. The number of movements should gradually increase. At the same time, flexion and extension movements of the shoulder and elbow joints should be performed. After the fracture heals, the external fixation should be removed early, and reasonable physical therapy should be applied. Comprehensive activities of the shoulder, elbow, and wrist joints should be performed, especially strengthening the exercise of clenching and releasing the fist, restoring muscle strength and muscle coordination function, and preventing functional disorders caused by muscle atrophy.

　　The auxiliary examination methods for distal radius fractures mainly include X-ray examination. X-ray films show typical displacement, with the following key points:

　　1. The distal radius fracture fragment is displaced towards the dorsal side.

　　2. The distal radius fracture fragment is displaced towards the radial side.

　　3. The radius is shortened, and the bone cortex at the fracture site is inserted or it is a comminuted fracture.

　　4. The fracture site angles towards the palm side.

　　5. The distal radial bone fragment is supinated.

　　In addition, subluxation or complete dislocation of the radius bone, and displacement of the distal radius fracture towards the radial side indicate a tear at the edge of the triangular cartilage, often accompanied by avulsion fracture of the ulnar styloid process, and a decrease or negative angle of the掌倾角 and 尺偏角.

　　Distal radius fractures can be divided into various types, which are more common in elderly women, and young and middle-aged people usually occur due to significant traumatic violence. Clinically, the wrist is swollen and painful, and there is a restriction in the movement of the hand and wrist. Patients should pay attention to their diet and can eat more of the following foods:

　　1, High-energy, high-protein diet:It helps to recover vitality. However, it is recommended to eat it after 2 weeks of the fracture. It is advisable to have light diet in the early stage of the fracture.

　　2, Vitamin D:If the patient has been confined to the room for a long time after the fracture and cannot get enough sunlight, it is easy to lack vitamin D. Therefore, after the fracture, it is necessary to eat more foods rich in vitamin D (such as fish, liver, egg yolks, etc.) and try to get more sunlight.

　　3, Vitamin C:Fruits rich in vitamin C include hawthorn, fresh jujube, kiwi, strawberry, longan, lychee, tangerine, etc., and vegetables include milk vetch (grass head), chili, bell pepper, rapeseed sprouts, cauliflower, sprouting broccoli (soup vegetables), bitter melon, watercress, green cauliflower, green amaranth, etc.

　　4, Water:Due to prolonged sitting and inactivity after the fracture, constipation is easy to occur, and more water should be drunk at this time to ensure intestinal smoothness.

　　Two weeks after the fracture, supplementary foods such as bone soup, Panax notoginseng chicken stew, animal liver, etc., can be taken to provide more vitamin A, D, calcium, and protein. More than 5 weeks after the fracture, the diet can be supplemented with old hen soup, pork bone soup, sheep bone soup, deer tendons soup, stewed fish, etc. Those who can drink can choose Du Zhong bone碎补酒, chicken blood vine wine, tiger bone papaya wine, etc.

　　For patients with malunited distal radius fractures causing dysfunction, surgical correction of deformity and internal fixation should be performed. For those with ulnar collateral ligament dislocation affecting forearm rotation, the ulnar head can be excised. For those with median nerve injury that does not recover after 3 months of observation, exploration and nerve release should be performed, and the protruding bone ends should be smoothed. For those with delayed rupture of the extensor pollicis longus tendon, bone spurs should be removed and tendons repaired. Osteoporotic patients should be given appropriate treatment to prevent the occurrence of complications of other severe fractures (such as femoral neck fracture).