Ortho Hors D'oeuvres (Answer):
To review, this is a 63 year-old man 24 hours status post fall on outstretched hands with left wrist pain.
Questions and Answers:
1) What is the key finding on x-ray? What is its eponym?
On these xrays you can see an obvious dorsally-displaced fracture of the distal radius. It does not appear to be intra-articular based on 3 views. This fracture is also known as a Colles fracture.
2) What are important neurovascular structures possibly endangered by this lesion?
Median nerve neuropathy (or acute carpal tunnel syndrome) can occur in 1-12% of low energy mechanisms leading to radial fractures (for example, a fall on outstretched hands) and up to 30% of high energy mechanisms leading to distal radial fractures. It is more likely to occur if the wrist is immobilized in a flexed position.
3) Does it need a closed reduction? What measurements can be used to verify an adequately reduced fracture?
This fracture absolutely needs to be reduced. There are three criteria for 'successful reduction' of a distal radius fracture that may eventually prevent future operative measures:
Radial shortening:
Measured by parallel lines drawn perpendicular to the radial shaft, through the radial styloid and the ulnar styloid. This distance is typically 13mm. If the radius has been shortened by more than 5mm, an increase in radius length must be attempted in reduction.
Volar tilt:
The angle between a line drawn perpendicular to the radial shaft and a line drawn across the articular surface of the radius in lateral view. Typical volar tilt is 10 degrees. If dorsal tilt is greater than 10 degrees, this must be adjusted during reduction.
Radial inclination:
The angle between a line drawn perpendicular to the radial shaft and a line drawn across the articular surface of the radius. Typical radial inclination is 20 degrees. If radial inclination is off more than 5 degrees, this must be adjusted during reduction.
References:
AAOS Guideline on the treatment of distal radius fractures. 2009.
Case courtesy of Dr Frank Gaillard, <a href="http://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="http://radiopaedia.org/cases/colles-fracture-1">Colles fracture</a>
Floyd WE, Earp BE, Blazar PE. Acute Median Nerve Problems in the Setting of Distal Radius Fracture. J Hand Surg Am. 2015 May 15.
