Stable radiusfractures fractures Stable distal distal radius Adults with an undisplaced fracture of their distal radius and no median nerve deficit can be safely discharged from the ER with: analgesia (Acetaminophen ± Ibuprofen) BE back-slab POP cast collar and cuff sling fracture clinic appointment
Unstable radiusfractures fractures Unstable distal distal radius Adults with a displaced fracture of their distal radius and normal median nerve function, after a lidocaine block and manipulation, can usually be discharged from the ER with: analgesia (Codeine) BE back-slab POP cast and sling fracture clinic OPA may need operation (ORIF with plate)
Colles’ ofdistal distalradius radius Colles’ fracture fracture of ‘dinner fork” deformity (look at skin contour)
extra-articular distal radius fracture with dorsal angulation (apex anterior)
Colles’ Colles’ fractures fractures Adults with a Colles’ fracture of their distal radius, after having a manipulation under a lidocaine block, may be discharged from the ER with: analgesia (Codeine) BE back-slab POP cast and sling fracture clinic appointment may need operation (ORIF with plate)
Smith’s of distal distalradius radius Smith’s fracture fracture of
Smith’s Smith’s fractures fractures Adults with a Smith’s fracture of their distal radius can usually be discharged from the ER with: analgesia (Codeine) BE volar slab POP cast and sling fracture clinic appointment will need operation (ORIF with plate)
Barton’s ofdistal distalradius radius Barton’s fracture fracture of
Barton’s = intra-articular distal radius fracture
usually volar displacement (dorsal = reverse Barton’s)
shear fracture (axial force)
Barton’s Barton’s fractures fractures Adults with a Barton’s fracture of their distal radius can usually be discharged from the ER with: analgesia (Codeine) BE volar slab POP cast and sling CT scan to assess joint fracture clinic appointment will need operation (ORIF with plate)
Radial fractures Radial styloid styloid fractures
“chauffeur’s fracture”
Radial fractures Radial styloid styloid fractures Adults with a radial styloid fracture can usually be discharged from the ER with: analgesia (Acetaminophen ± Ibuprofen) BE back-slab POP cast and sling CT scan to assess joint fracture clinic appointment may need operation (ORIF with screw)
Distal Distal ulnar ulnar injuries injuries
ulnar styloid fractures
distal ulnar fractures
Galeazzi dislocation
Distal Distal ulnar ulnar fracture fracture
seen in severe osteoporosis
Distal Distal ulnar ulnar fractures fractures Adults with a distal ulna fracture can usually be discharged from the ER with: analgesia (Acetaminophen ± Ibuprofen) BE back-slab POP cast and sling fracture clinic appointment may need operation (ORIF with plate)
Ulnar fracture Ulnar styloid styloid fracture
represents avulsion injury to TFCC
TFCC
fibrous union is common
Ulnar fractures Ulnar styloid styloid fractures Adults with an isolated ulnar styloid fracture can be discharged from the ER with: analgesia (Acetaminophen ± Ibuprofen) BE back-slab POP cast fracture clinic appointment (MRI?) may need operation (repair of TFCC?)
Galeazzi Galeazzi fracture-dislocations fracture-dislocations Adults with a distal radial shaft fracture with dislocation of the ulnar head must be admitted urgently from the ER for: analgesia (iv Acetaminophen or Morphine) AE back-slab POP cast keep NBM (for ORIF with plate) operation on next trauma list in the OR
Scaphoid fracture Scaphoid fracture
nonunion is common
impingement on radial styloid with FOOSH causes fracture
Scaphoid fractures Scaphoid fractures Adults with a scaphoid fracture (undisplaced or displaced) can be discharged from the ER with: analgesia (Acetaminophen ± Ibuprofen) BE radial slab POP cast up to thumb IPJ collar and cuff sling fracture clinic appointment may need operation (ORIF with screw)
