1. Fractures of the distal radius

2. Colles` fracture

3. This fracture is described by Ibraham colles` in 1814 .
It is a transverse fracture of the distal end of the radius with posterior displacement of the distal fragment.
It is the most common of all fractures in the human being ; mainly in old osteoporotic people , but it occur in all age groups .
It is occur due to fall on out stretched hands

6. X-ray : there is transverse fracture of the
Clinically :
The deformity of this fracture called dinner – fork deformity .
The patient also has the sign and symptoms of any other fracture like pain , tenderness , loss of function , swelling …..etc .
X-ray : there is transverse fracture of the
radius at the cortico – cancellous
junction , and the distal fragment is displaced posteriorly ; some time it is severely comminuted or crushed .

12. Treatment :
It must be reduced under general anesthesia, the reduction will be by traction on the hand in the length of the bone , the distal fragment then pushed into place by pressing on the dorsum while manipulating the wrist into flexion , ulnar deviation and pronation

13. Then put back slab and check by x-ray .
The back slab from below elbow to the neck of the metacarpals .
Extreme pronation , flexion and ulnar deviation must be avoided ; 20` in each direction is adequate .
Shoulder and fingers exercise then started .
After 7-10 days remove the slab and do full
p.o.p. . The fracture usually unite in 6 weeks

15. Complication : early : 1-vascular damage
radial artery (rare) .
2- nerve damage median nerve (rare) .
Late complication :
1- malunion : it is common due to
unreduced fracture or due to
redislpacement .
2- delayed union and non union .
3-stiffness of the wrist ,fingers, elbow and shoulder
4-tendon rupture of extensor polices longus .
5- sudeck`s dystrophy (localized sympathetic over
activity).
6-carpal- tunnel syndrome .
Smith fracture :it is the same as colles` fracture but the
distal segment is displaced anteriorly .

18. Radial styloid process fracture :
Here the fracture line extend from the articular surface of the radius laterally .
Treatment :
If there is displacement , the fracture should be reduced by manipulation under anesthesia , then back slab below elbow tell the neck of the metacarpal ; imperfect reduction will lead to osteoarthritis , so if the fracture not reduced perfectly by manipulation then open reduction and fixation by screw or k wire .

21. BARTON`S FRACTURE 1- volar Barton's`: called true Barton fracture and
It is intra articular fracture of the lower end of the radius with subluxation of the wrist joint .
It is of two types :
1- volar Barton's`: called true Barton fracture and
it associated with volar subluxation of the carpus . The fracture line run obliquely across the volar lip of the radius into the wrist joint . The distal segment displaced anteriorly carrying the carpus with it .
Treatment : the fracture easily reduced but it is unstable so
it can easily redisplaced so the treatment will be by open reduction and fixation by special plate called Buttress plate .
2- dorsal Barton`s: it is the reverse of the volar one .

24. Fracture scaphoid bone
It is caused by fall on out stretched hands ; the most important point in scaphoid is its blood supply inter the bone from distal to proximal direction , so the blood supply is decreased from distal to proximal ; this fact explain why only 1% of the fracture in the distal third of scaphoid , 20% of the fract. In the middle third and 40% of the proximal third fract. Will develop avascular necrosis and non union .

26. Clinically : there is fullness and tenderness in the
anatomical snuff box ; other diagnostic sign is that, proximal pressure along the axis of the thumb is painful .
X-ray : a-p , lateral and oblique views are all
essentials . Some time recent fracture show it self only in oblique view .
Usually the fracture is transverse and through the narrowest part of the bone (the waist) , but it could be in the proximal pole or in the tubercle ; few weeks after injury the fracture will be more obvious

27. Fracture scaphoid

28. If union is delayed , cavitation appear on either side of the fracture .
In old ununited fracture there will be sclerosis at the edge and the appearance will be as there is extra carpal bone .
Sclerosis of the proximal fragment is path gnomonic of avascular necrosis of the proximal fragment .

29. Treatment : Undisplaced fracture : conservative
treatment by p.o.p. cast in 90% of the cases will heal ; the cast will be applied from upper forearm to just short of the metacarpophalangeal joint of the fingers but it should incorporating the proximal phalanx of the thumb ; the wrist is held in dorsiflexion and the thumb forward in ( GLASS HOLDING ) position and it should be retained for 6 weeks .
After 6 weeks the p.o.p. removed and the wrist examined clinically and radiologically , if there is no tenderness and the x-ray show sign of healing , the wrist is left free

30. Displaced fracture : treatment by open
If there is local tenderness or the fracture is still visible in x-ray , the p.o.p. is reapplied for further 6 weeks and after that either the wrist become painless and the fracture healed so the p.o.p. removed or the x-ray show sign of delayed healing then we should do fixation and bone grafting .
Displaced fracture : treatment by open
reduction and fixation by
compression screw .

32. Complication 1- avascular necrosis :
the proximal fragment may die especially
with proximal pole fracture , it will appear
dense on x-ray .
Treatment : by excision of the proximal
fragment .
2- non union : after 3 months if fracture not
united it will be obvious that the fracture will not
unite at all .
Treatment :in old people and in those who are completely asymptomatic , non union may be left untreated .
In young patients treatment by fixation and bone grafting .

33. non union fracture scaphoid

34. Avascular necrosis of proximal segment of scaphoid frac.

35. If the graft fail then do excision of the scaphoid and fusion of the carpel bones .
3- osteoarthritis :
non union and avascular necrosis may
lead to secondary osteoarthritis .