OWL: OCOSH Classification/Trauma/Fractures/Radius Fractures/Distal Radius Fractures/Radial Styloid Fracture

Greater arc injury of the wrist with fractured lunate bone

Amaravati et al — 2009-11-12 00:20:36 GMT

Carpal dislocation and fracture dislocation are uncommon and difficult to treat. Early diagnosis and treatment of such injuries are necessary to prevent progressive carpal instability and traumatic arthritis. Perilunate fracture dislocation is a combination of ligamentous and osseous injuries that involve the �greater arc� of the perilunate. Despite being severe, these injuries often go unrecognised in the emergency department, leading to delayed diagnosis and treatment. We present a case of greater arc injury of the right wrist with fractures of the lunate and ulnar styloid without perilunate dislocation. This pattern of injury cannot be classified in the available literature on greater arc injury.
Greater arc injury of the wrist with fractured lunate bone: a case report RS Amaravati, MJ Saji, HP Rajagopal Journal of Orthopaedic Surgery 2005:13(3):310-313 Full text

How to Classify Distal Radius Fractures eRadius

Not Available — 2009-11-12 00:20:36 GMT

The IFSSH Board of Directors wished to examine the potential for a universal classification of fractures and dislocations of the hand and wrist. If this could be accomplished, classifications could be standardized as a constant. The method of treatment would then be the variable. Scientific method would then be applied to analyze different outcome parameters. This would allow a comparative assessment of treatment methods between two or more groups throughout the world. It would allow the accumulation of data by the addition of related series of cases. This would add power to the validity of the conclusions reached by statistical analysis.
Our charge was to initiate the classification process in the targeted area of distal radial fractures. We were asked to examine existing classifications and select one, or modify, combine, or otherwise formulate and endorse a classification system for distal radial fractures. The classification system selected must be sufficiently simple so that it could be applied in undeveloped countries, and yet allow for the contribution of sophisticated analytical technology where it exists. It must provide intra-observer and inter-observer reliability. It should serve as a discriminator for treatment and outcome expectations.

Ligamentotaxis for Barton's and paediatric distal radial fractures

Lakshmanan et al — 2009-11-12 00:20:36 GMT

PURPOSE: To establish a consensus regarding immobilisation of the wrist following reduction of Barton's and paediatric distal radial fractures. METHODS: Questionnaires were distributed to orthopaedic surgeons at the European Federation of National Associations of Orthopaedics and Traumatology meeting in Lisbon in 2005. Questions included the surgeon's country of practice, hospital, professional grade, years of experience, sub-specialty, and preferred position of wrist immobilisation after (1) a volar Barton's fracture, (2) a dorsal Barton's fracture, (3) a paediatric Salter-Harris type-II injury to the distal radius with volar displacement, and (4) the same injury but with dorsal displacement. RESULTS: Of 148 questionnaires distributed, 118 were returned. The specialist-to-trainee ratio was 45:73. In volar Barton's fractures, only 20% (29% specialists and 15% trainees) would immobilize the wrist in palmar flexion, as per recommendations. In dorsal Barton's fractures, only 25% (33% specialists and 21% trainees) would immobilize the wrist in dorsiflexion, as per recommendation. In paediatric Salter Harris type-II injury to the distal radius with volar displacement, 87% (100% specialists and 79% trainees) would immobilize the wrist in dorsiflexion or in a neutral position, as per recommendation. In the same injury but with dorsal displacement, 84% (89% specialists and 81% trainees) would immobilize the wrist in palmar flexion or in a neutral position, as per recommendation. In all 4 types of fractures, 26% to 30% of respondents would immobilize the wrist in a neutral position. CONCLUSION: Most respondents deviate from the recommended immobilisation positions in treating Barton's fractures. Understanding of the anatomy or biomechanics of ligamentotaxis are crucial for conservative treatments.
Ligamentotaxis for Barton's and paediatric distal radial fractures. Lakshmanan P, Sayana MK, Purushothaman B, Sher JL. J Orthop Surg (Hong Kong). 2009 Apr;17(1):28-30.

Radial Styloid Fractures Wheeless

C.R.Wheeless — 2009-11-12 00:20:36 GMT

Chauffeur's Fracture: Radial Styloid Fractures
Discussion:
radial styloid fractures most commonly occur from tension forces sustained during ulnar deviation and supination of the wrist;
strong radiocarpal ligament, particularly radioscaphocapitate ligament, avulse radial styloid from metaphysis of the radius;
ligamentous attachments maintains alignment radial styloid to carpus, but styloid may be markedly displaced from the rest of radius;
brachioradialis & extrinsic wrist & finger flexors & extensors exert powerful displacing force on carpus/radial styloid complex;
fractures of styloid are frequently accompanied by dislocations of lunate;
Associated Injuries:
- Scapholunate Dissociation:
- Transstyloid Perilunar Dislocation:
- Dorsal Barton's:

Transradial styloid transscaphoid perilunate fracture-dislocation

Not Available — 2009-11-12 00:20:36 GMT

Transradial styloid perilunate fracture-dislocation represents greater arc (Gilula's arcs) injury.
Greater arc injuries may be divided into following stages based on their severity:
Stage I: transradial styloid perilunate fracture-dislocation;
Stage II: transscaphoid perilunate fracture-dislocation;
Stage III: transscaphoid, transcapitate perilunate fracture-dislocation;
Stage IV: transscaphoid (or radial styloid), transcapitate, transtriquetral perilunate fracture-dislocation; and
Stage V: complete palmar lunate dislocation associated with carpal fractures.

Two Unusual Cases of Coronal Lunate Fracture

Eric P. Hofmeister, MD; Safi Faruqui, DO — 2009-11-12 00:20:36 GMT

Volar lunate fractures are rare injuries, usually seen as a result of high-energy trauma and often in association of other carpal injuries. We present 2 unusual cases of coronal volar lunate fractures. The first case involved a proximal pole scaphoid fracture in association with a volar lunate fracture. During surgical exposure, the lunate fracture was found to be rotated 180� volarly. This displaced lunate fracture, although appearing small on radiographs, consisted of the entire volar half of the capitate facet of the distal lunate. Both the scaphoid and lunate fractures were anatomically reduced with fixation across the fractures.
The second case was the result of a high-energy injury and included a transscaphoid, transtriquetral, translunate facture dislocation with a comminuted radial styloid fracture and a small ulnar styloid fracture. Operative reduction and internal fixation was performed of the scaphoid and lunate. The triquetral and comminuted radial styloid fractures were stabilized with K-wires. In both cases, following splinting and rehabilitation, an excellent functional outcome was obtained.
Early recognition and operative treatment of these unusual lunate fractures in association with treatment of the concomitant injuries using an extended volar approach with open reduction internal fixation can lead to an excellent anatomic and functional outcome in these types of cases.
Two Unusual Cases of Coronal Lunate Fracture By Eric P. Hofmeister, MD; Safi Faruqui, DO ORTHOPEDICS 2009; 32:290