FRAKTUR COLLES – Download as Powerpoint Presentation .ppt), PDF File .pdf ), Text File .txt) or view presentation slides online. fr. colles. The Irish surgeon Abraham Colles described DRFs in the volume of the Edinburgh Medical Surgical Journal. Although his description. lokasi fraktur yang paling umum adalah di tangan dan melibatkan bagian distal dari tulang radius, bernama Fraktur Colles. Fraktur Colles adalah fraktur pada.
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PA view should be taken with the wrist and elbow at shoulder height. This means that the wrist, elbow and shoulder are all in the transverse plane, perpendicular to the x-ray beam.
Only in this position, the radius and the ulna are parallel. Colkes the arm makes the radius cross the ulna and become relatively shorter resulting in improper measurement of the length of the radius.
Lateral view is taken with the elbow adducted to the side. Shoulder, elbow and wrist are again in one plane, i.
This positioning will make the lateral view exactly perpendicular to the PA view. On a correctly positioned PA view the extensor carpi ulnaris tendon groove arrow can be seen. The extensor carpi ulnaris tendon groove should be at the level of or radial to the base of the ulnar styloid.
A true lateral view is defined by the relationship between the pisiforme, capitate and scaphoid bones. On a standard lateral view, the palmar cortex of the pisiform bone should overlie the central third of the interval between the palmar cortices of the distal scaphoid pole and the capitate head. Apparent volar tilt of the surface of the distal radius, as measured on the lateral view, increases with supination and decreases with pronation of the wrist 5.
A change of 10 degrees rotation between two consecutive control lateral radiographs is not uncommon during clinical follow-up and results in 5 degrees change in apparent tilt. CT should be performed if conventional radiographs provide insufficient detail about radiocarpal articular step-off and gap displacement.
On the left a patient with a communitive intraarticular fracture of the distal radius with displacement of the volar rim of the radius together with the carpus i. There is an axial CT image with 3D- coronal and sagittal reconstructiosn. On the left sagittal reconstructions of 1mm axial CT slices. Scroll through the images and notice how well CT demonstrates the fracture components and the displacement. Magnetic resonance MR imaging is of benefit when concomitant injuries of ligaments and triangular fibrocartilage complex TFCC are suspected or if a fracture is suspected but not demonstrated on routine radiographs.
On the left a fracture of the ulnar styloid process not visible on standard radiography, but clearly demonstrated with MR. Radial length or height Radial length is measured on the PA radiograph as the distance between one line perpendicular to the long axis of the radius passing through the distal tip of the radial styloid.
A second line intersects distal articular surface of ulnar head. This measurement averages mm. Radial inclination or angle Radial inclination represents the angle between one line connecting the radial styloid tip and the ulnar aspect of the distal radius and a second line perpendicular to the longitudinal axis of the radius.
The radial inclination ranges between 21 and 25 degrees. Loss of radial inclination will increase the load across the lunate. Radial tilt Radial tilt is measured on a lateral radiograph.
The radial tilt represents the angle between a line along the distal radial articular surface and the line perpendicular to the longitudinal axis of the radius at the joint margin. The normal volar tilt averages 11 degrees and has a range of degrees.
Colles fracture | Radiology Reference Article |
There vraktur many ways to describe distal collles fractures and there are several classification systems. In clinical practice however frequently eponyms like Colles’ and Barton’s are used. When these epomyms are used, an accurate description of the fracture characteristics vraktur always be included in the report 5. In addition it should also be noted if there is osteoporosis or additional findings such as ligamentous injuries. One of the most important characteristics is whether a fracture is extraarticular or intraarticular.
Extraarticular fractures are usually less complicated, unless they are comminutive. Intraarticular fractures either involve the radiocarpal joint, distal radioulnar joint, or both. Always mention whether the fracture is transverse good prognosisoblique or comminuted multifragmented. Collea a fracture is oblique or when it is comminuted with crossing of the mid axial line, it can be unstable. On the left a patient with an extraarticular distal radius frzktur.
Notice the oblique course on the lateral view. Fractures with this configuration frequently show loss of reduction at follow up and need surgical treatment. On the left a sagittal reconstruction of an oblique intraarticular fracture of the distal radius. This is a volar Barton’s type fracture. Even in a cast the volar fragment will show progressive displacement at follow-up and a volar buttress plate is needed to hold the volar rim in place.
Fractures are either displaced or nondisplaced.
A fracture with an offset of 2 mm or more in any plane or 2 mm offset involving the articular surface is considered displaced. Displacement can be dorsal, volar, radial or proximal. Dorsal tilt and dorsal or palmar displacement can be measured on the routine lateral X-ray.
Fragment displacement and rotation may be further determined using CT. Instability is defined as a high risk of secondary displacement after initial adequate reduction.
Radiographic signs that favor instability are displacement and an oblique or comminuted configuration as fdaktur above. These signs are listed in the table on the left. Although the initial x-ray after reduction may look good, always look for loss of reduction at follow up. Articular incongruity is the most important factor in the development of posttraumatic osteoarthritis of the wrist. Assessment of a wrist fracture must also include a description of the distal ulna and distal radioulnar joint 9.
The distal ulna articulates with the sigmoid notch of the radius. Following reduction of the radius the DRUJ is congruent and stable. Extraarticular unstable fractures however, require plate fixation.
The subluxation has colled be reduced with closed or operative treatment to avoid chronic instability and arthosis. Rraktur Colles’ fracture is a fracture of the distal metaphysis of the radius with dorsal fraktyr and displacement leading to a ‘silver fork deformity’. Colles fractures are seen more frequently with advancing age and in women with osteoporosis.
In many cases a Colles’ fracture is an extraarticular, uncomplicated and stable fracture, but it can be intraarticular. So look for signs of instability in all Colles’ fractures, especially:. On the collrs a detailed AP view of the same patient as above. In addition to the dorsal angulation seen on the lateral view, notice the following:. Just calling this fracture a Colles’ fracture would be insufficient.
Wrist – Fractures
All the characteristics have to be fraktru in the radiology report to convey the full extent of the injury, possible complications and treatment.
Smith’s fractures occur in younger patients and are the result of high energy trauma on the volar flexed wrist. Volar comminution and intraarticular extension are more common.
On the left an extraarticular Smith’s fracture with palmar and radial angulation and displacement. There is also an avulsion of the ulnar styloid process. Volar-type Barton’s is a fracture-dislocation of the volar rim of the radius. This type is the most common. Dislocation of the radiocarpal volles is the hallmark of Barton’s fractures. These are shear type fractures of the distal articular surface of the radius with translation of the distal radial fragment and the carpus.
These fractures have a great tendency for redislocation and malunion. They usually require operative treatment. A die-punch fracture is a depression fracture of the lunate fossa of the distal radius. It is the result of a transverse load through the lunate. The radiographic findings can be very subtle.
In many cases there is also a subtle proximal displacement of lunate, seen as a break in carpal arc I.
On the left a typical die-punch fracture. The blue arrow indicates the depressed fragment of the lunate fossa. Notice the articular step-off. The yellow arrow indicates a subtle fracture of the radial styloid process. There is no disruption of carpal arc I. Notice that you can easily overlook such a fracture. An isolated fracture of the radial styloid process is also called a Hutchinson’s or chauffeur’s fracture. Displacement of the fragment is uncommon. There can be associated injury to the scapholunate ligament.
In most cases a fracture of the radial styloid process is part of a comminutive intraarticular fracture. Ulnar styloid process fracture An ulnar styloid process fracture is usually associated with radial fractures and rarely isolated. An isolated fracture of the tip is clinically insignificant. Displaced fractures of the base are usually associated with TFC tears and can be associated with instability of the distal radioulnar joint DRUJ.
On the left a subtle fracture of the tip of the ulnar styloid process blue arrow in a patient with a volar Barton’s fracture. Notice the depression of the volar rim. Torus fractures, or buckle fractures, are extremely common injuries in children.
Because children have softer bones, one side of the bone may buckle. The word torus is derived from the Latin word ‘Tori’ meaning swelling or protuberance.