Closed Reduction of a Distal Radius Fracture

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18007   4 years ago
samer176 | 7 subscribers
18007   4 years ago
Closed Reduction of Distal Radius Fractures

- Discussion: (distal radius fracture menu)

- closed reduction & immobilization in plaster cast remains accepted method of treatment for majority of stable distal radius frx;
- unstable fractures will often lose reduction in the cast and will slip back to the pre-reduction position;
- patients should be examined for carpal tunnel symptoms before and after reduction;
- carpal tunnel symptoms that do not resolve following reduction will require carpal tunnel release;
- cautions:
- The efficacy of closed reduction in displaced distal radius fractures.

- Technique:
- anesthesia: (see: anesthesia menu)
- hematoma block w/ lidocaine;
- w/ hematoma block surgeon should look for "flash back" of blood from hematoma, prior to injection;
- references:
- Regional anesthesia preferable for Colles' fracture. Controlled comparison with local anesthesia.
- Neurological complications of dynamic reduction of Colles' fractures without anesthesia compared with traditional manipulation after local infiltration anesthesia.
- methods of reduction:
- Jones method: involves increasing deformity, applying traction, and immobilizing hand & wrist in reduced position;
- placing hand & wrist in too much flexion (Cotton-Loder position) leads to median nerve compression & stiff fingers;
- Bohler advocated longitudinal traction followed by extension and realignment;
- consider hyper-extending the distal fragment, and then translating it distally (while in extended position) until it can be "hooked over" proximal fragment;
- subsequently, the distal fragment can be flexed (or hinged) over the proximal shaft fragment;
- closed reduction of distal radius fractures is facilitated by having an assistant provide counter traction (above the elbow) while the surgeon controls the distal fragment w/ both hands (both thumbs over the dorsal surface of the distal fragment);
- flouroscopy:
- it allows a quick, gentle, and complete reduction;
- prepare are by prewrapping the arm w/ sheet cotton and have the plaster or fibroglass ready;
- if flouroscopy is not available, then do not pre-wrap the extremity w/ cotton;
- it will be necessary to palpate the landmarks (outer shaped of radius, radial styloid, and Lister's tubercle, in order to judge success of reduction;
- casting:
- generally, the surgeon will use a pre-measured double sugar sugar tong splint, which is 6-8 layers in thickness;
- more than 8 layers of plaster can cause full thickness burns:
- reference: Setting temperatures of synthetic casts.
- position of immobilization
- follow up:
- radiographs:
- repeat radiographs are required weekly for 2-3 weeks to ensure that there is maintenance of the reduction;
- a fracture reduction that slips should be considered to be unstable and probably require fixation with (pins, or ex fix ect.)
- there is some evidence that remanipulation following fracture displacement in cast is not effective for these fractures;
- ultimately, whether or not a patient is satisfied with the results of non operative treatment depends heavily on th
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