![]() ![]() Type IV fractures are avulsion fractures of ligamentous attachments, including ulnar and radial styloid fractures associated with radiocarpal fracture-dislocations. Type III fractures are compression fractures of the joint surface with impaction of the subchondral and metaphyseal trabecular bone. Type II fractures are shearing fractures of the joint surface. Type I fractures are bending fractures of the metaphysis in which one cortex fails because of tension stress, and the opposite cortex shows a certain degree of comminution. In this classification, distal radius fractures are divided into five major types ( Fig. a Colles’ fracture b Smith’ fracture c Barton’ fracture d Reverse Barton’ fracture e Chauffeur’ fracture f Punch fracture g Greenstick fracture h Galeazzi’s fracture 1a-h Classification of distal radius fractures according to eponyms and synonyms. ![]() We have found the classification system of Fernandez extremely helpful in decision making in our clinical practice and the AO/ASIF Comprehensive Classification of Fractures useful in preparing scientific papers. A fracture classification should help the surgeon to choose an appropriate method of treatment for any given fracture and should allow estimation of the outcome of treatment. It must have a high degree of inter-observer and intra-observer reliability. Any fracture classification must consider the severity of the bone lesion and serve as a basis for treatment and evaluation of the outcome. However, a classification system is necessary for effective description of the individual characteristics of specific fractures. ![]() Despite the fact that the observations of Colles, Barton, Smith, Pouteau, and Goyrand-to name just a few-were made solely from postmortem specimens, their descriptions of fracture morphology have served as guidelines for surgeons for more than 150 years and still provide a comfortable base for communication among clinicians. There are few areas of skeletal trauma in which eponymic descriptions are so commonly used as with fractures of the distal radius ( Table 17.1, Fig. Cortical layer completely fractured on the convex side, but only cracked on the concave sideįracture of the distal third of the radius combined with dislocation in the distal radioulnar joint Impression of the lunate fossa of the radius 1 Classification of distal radius fractures by eponyms and synonymsįracture through the radial styloid process Thus, the isolated fracture of the distal radius typically occurs in the relatively fit osteoporotic individual, whereas fractures of the distal end of the radius associated with ipsilateral limb trauma are found with increasing frequency in young, active adults, due in part to a higher incidence of high-energy trauma or participation in sports and similar activities. It has been suggested that the decrease in fractures of the distal radius after age 69 reflects increasing frailty resulting in an inability to extend the upper limb in protection, with the result that distal radius fractures are less common and hip fractures are more common. Indeed, lowbone mineral density is found in most elderlywomen with a distal radius fracture, and osteoporosis is diagnosed in more than 50%. These factors all support a strong association of radius fractures with osteoporosis. The mechanism of injury is usually a fall from standing height rather than a highenergy mechanism. ![]() The epidemiological understanding of fractures of the distal radius is based primarily on Scandinavian studies, which have revealed that distal radius fractures are more common in women than in men, with an incidence increasing rapidly after menopause and reaching a maximum between 60 and 69 years. Fractures of the distal radius are among the most common injuries sustained, accounting for upwards of onesixth of all fractures seen and treated in the emergency room. ![]()
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