Distal Radius Fractures - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describing different concepts of distal radius fractures.
Highlight points about distal radius fractures:
1- The fracture being extra- or intra- articular: the intra-articular fractures are usually worse than the extra- articular fractures.
Fracture of the distal radius has many types and classifications:
• Fernandes.
• Frykman.
• Melone.
• Three Column Theory.
• AO.
Each type will require a specific management and not all of them can be treated with a cast.
2- May be DRUJ or ulnar styloid process injuries:
Ulnar styloid process injury may not need to be fixed.
Fix the radius first and then test the joint.
if it is grossly unstable, fix the radioulnar joint, or you can fix the ulnarstyloid process if the fracture is big
extensor carpi ulnaris tendon entrapment can cause irreducible dorsal dislocation of the ulna.
3- Osteoporosis:
Osteoporosis is a decrease in bone strength.
Osteoporitic bone is at risk of fracture at the hip, spine, and wrist.
DEXA scan is used to study the bone mass to prevent future fracture of the spine and hip.
Wrist fractures occur at a younger age than fractures of the spine and hip.
4- Extensor Pollicis Longus rupture:
The EPL tendon is commonly ruptured due to nondisplaced fractures of the distal radius (attrition rupture).
It can occur from a prominent hardware.
When screws are used, they should not penetrate the dorsal cortex to avoid injuring the EPL tendon.
Rupture of the EPL tendon is usually treated with transfer of the extensor indicis tendon.
NOTE: FPL rupture can be seen with prominent volar hardware.
5- Vitamin C use for reflex sympathetic dystrophy (RSD):
500 milligrams of vitamin C is given every day for 50 days.
Reflex sympathetic dystrophy is a clinical syndrome of variable course and unknown cause characterized by pain, swelling, and vasomotor dysfunction of an extremity.
This condition is often the result of trauma or surgery.
6- Acute Carpal Tunnel Syndrome:
Carpal tunnel syndrome is a common condition following a distal radius fracture.
Surgical release of the carpal tunnel and fracture fixation should be performed urgently.
It can also occur following ORIF of the distal radius fracture.
The patient will have dense numbness in the distribution of the median nerve after surgery especially after supraclavicular regional anesthesia wear off.
Do immediate open carpal tunnel release.
Treatment of distal radius:
• Therapy may not be needed routinely; it has the same result as home exercises.
• It is important to get the fingers moving as soon as possible (there is no need for early wrist motion even if the radius fixation is stable).
Surgery:
• Dorsal and volar planting das no difference in complication.
• Dorsal planting is used for dorsal shearing fracture.
• Volar planting is routinely used for most of these fractures.
• External fixation is less desirable.
• The American Academy of Orthopaedic Surgeons (AAOS) wants less than 10° of dorsal tilt; the normal amount of tilt is 12° of volar tilt.
• The AAOS wants radial inclination angle loss of less than 10°.
• The normal angle is 23°.
• Radial shortening should be less than 3 mm.
• Intra- articular step off of less than 2mm. Arthritis correlates with step off more than 2mm (may not be symptomatic).
Guidelines for Reduction:
• With older patients, you can go with nonanatomic reduction and casting.
• Patients younger than 55 years of age, surgery is recommended for optimal reduction if the fracture is displaced.
• For patients above 55 years of age, the optimal treatment is not clear.
• Radius malunion can create a DISI deformity which can be treated with osteotomy and correction of the deformity.
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[@blessingmunyawiri5982]

This professional knows his stuff .Subscribe to him

[@petergianakopoulos4926]

No

[@Checcles]

Thank you for all your videos. Can you please start doing common surgical approaches videos? (tib plateau / distal radius / etc)

[@simplegirl9504]

JazakAllahu khairan sir

[@arsalanebrahimi1990]

appreciate the effort doctor.

[@frankw2m]

Saludos desde CD. Juárez! Adoro sus videos doctor. Soy médico interno en un hospital empezando su rotacion por ortopedia y traumatologia. Sus videos me han ayudado muchísimo!

[@stonjes11]

Helpful for education and understanding

[@victormanuelbisbee7449]

Do you have any colles fracture video?

[@redvalenciamd]

Thank you

[@aleksandarstepanovic787]

Why is external fixation less desirable? I have that now

[@geojor]

thank you for this...

[@srinivasaraosirasapalli5104]

awesome

[@anantprakashmisra1267]

Very nice

[@pappurawat6862]

nice

[@atthewarre4063]

I GUESS....CANT GET MOST OF WHAT HE SAYS.

[@neelavenketraju2258]

Thanks for the update

[@dr.monirhossain8678]

Sir ,if you give your normal voice in this video,it will be more attractive