Distal Radius Fxs Rockwood Pearls

Front 1

Acceptable Parameters for Healed Radius Fracture in Active Healthy patient:

Back 1

Radial Length within 2-3mm of cotnralateral
Palmart Tilt to neutral
Intraarticular stepoff <2mm
Radial Angle <5 degree loss
Carpal malalignment absent

Front 2

At what distance of radial shortening can you know that you have DRUJ disruption?

Back 2

5mm (based on cadaveric study)

Front 3

What is an Essex Lopresti Lesion?

Back 3

Combined Injuries to the DRUJ + IO Membrane + Radial Head

Front 4

Indications for an Emergent Carpal Tunnel Decompression

Back 4

Worsening of Median Nerve Symptoms after radiographic and clinical reduction with elevation above heart and oral narcotics. Take down the dressing, apply ice, if no relief within 6 hours --> immediate decompression (Rockwood & Green p831)

Front 5

Radial Length & Ulnar variance

Back 5

measured along the axis of the radius, difference between ulnar head (ignoring styloid) and and the radial styloid
Ulnar variance
measured along the axis of the radius, difference between the ulnar head (ignoring the styloid) and the medial courner of the articular surface of the radius\
NB: Ulnar Variance and Radial Length will not change in step if there is loss of radial inclination
NB: Rockwood Acceptable Parameters for Healed Radius Fracture in Active Healthy patient: Radial Length within 2-3 mm of contralateral wrist

Front 6

Radial Inclination

Back 6

angle between radial styloid and medial corner of radius vs long axis of radius
NB: Rockwood Acceptable Parameters for Healed Radius Fracture in Active Healthy patient: <5 degree loss

Front 7

Carpal Malalignment

Back 7

carpus flexes to compensate for malaligned radius
line drawn along long axis of acapitate and along long axis of radius on lateral view
if carpus is aligned then intersection will be within carpus, if outside then malaligned
NB: Rockwood Acceptable Parameters for Healed Radius Fracture in Active Healthy patient: No carpal malalignment is acceptable

Front 8

Rotation from your true lateral view and its effect on assessment

Back 8

5 degree rotational change produces 1.6 degree change in palmar tilt on conventional lateral view
(and a 1 degree change on 15 degree lateral view)

Front 9

Tileted Lateral View

Back 9

20 degree inclination allows visualization of lunate facet

Front 10

Palmar Tilt & Loss Thereof

Back 10

Loss of normal 11-12 degrees = 80% risk of arthritis
the area of maximumload on radius becomes more concentrated and shifts dorsally
increases tension on palmar and dorsal radioulnar ligaments resulting in an increased load required for forearm rotation
NB: Rockwood Acceptable Parameters for Healed Radius Fracture in Active Healthy patient: No greater than neutral

Front 11

ulnar variance loss

Back 11

loss of 2mm of ulnar variance results in symptomatic loss of strength
loss of 4mm results in pain

Front 12

Which distal radius corteces are thick vs thin:

Back 12

thinner dorsally and radially: collapse typically happens dorsoradially
thickest trabecular bone in palmar ulnar cortexs

Front 13

What is the keystone of the radius

Back 13

palmar ulnar corner: attachemtn for palmar distal RULigs and stout radiolunate ligament
displacement drags the lunate and blocks forearm rotation

Front 14

What is important about the orientation of the palmar extrinsic ligament:

Back 14

from aradial styloid is more oblique relative to those attached to lunate facet
palmar are thicker and stronger and pull traction earlier than Z shaped dorsal ligament: very difficult to obtain palmar tilt

Front 15

Prediction of instability:

Back 15

Elderly, lots of initial displacement, lots of metaphyseal comminution, displacement after closed treatment

Front 16

Indications for operative intervention:

Back 16

Predicated or established metaphyseal instability
comminuted displaced intraarticular fracture
open fracture
associated carpal fractures
associated neurovascular injury/tendon injury
Bilateral
impaired contralateral extremity

Front 17

Agee maneuver

Back 17

for distal radius fracture:
traction, a volar translation force to distal radius

Front 18

Timing of distal radius fracture surgical fixation:

Back 18

immediately unless using arthroscopy in which case wait for 5-15 days for capsule to close

Front 19

perc pinning vs age

Back 19

no benefit in older patients

Front 20

major complication of K wires

Back 20

damage to superficial branch of radial nerve

Front 21

benefits & contraindication to non-brdiging ex fix

Back 21

benefits: volar tilt
contras: lack of space for pins
need 1 cm of intact volar cortex;
not suitable for volar displaced fractures
NB: neither comminution nor osteoporosis is contraindication

Front 22

Indication for palmar plates, where is incision

Back 22

dorsall comminution or partial articular fractures (shear)
incision over FCR
OR over palmaris longus between flexor tendon/ulnar neruovascular bundle interval

Front 23

indications for corrective osteotomy:

Back 23

subluxation of radiocarpal joint
articular incongruity >2mm on AP

Front 24

Complexs regional pain syndrome type 1 vs 2

Back 24

Type 1: absnce of nerve path
2: with nerve damage