![]() ![]() Named for Giovanni Battista Monteggia (1762-1815), an Italian surgeon who first described the fracture in 1814. ![]() The majority undergo ORIF for the radial fracture and K-wire fixation of the DRUJ. As such, they require emergent orthopedic evaluation for reduction and immobilization. ![]() These fractures uniformly result in disruption of the distal radioulnar joint (DRUJ) and damage to the triangular fibrocartilage complex (TFCC). They generally occur as a FOOSH with a flexed elbow. These fracture-dislocations are more common in children with a peak incidence from 9-12. The radius can displace either dorsally (type I) or volarly (type 2), with dorsal displacement being much more common. A direct blow to the radius is a less common cause. The fracture is described as a distal 1/3 rd radial shaft fracture with dislocation of the distal radioulnar joint with an intact ulna. This causes the scaphoid to impact the radial stylus, resulting in compression.įirst described by Riccardo Galeazzi (1866-1952), an orthopedist from Italy in 1934. The fracture is also seen in FOOSH injuries with extension and abduction of the wrist. The second is from a FOOSH with ulnar seviation and supination, leading to avulsion of the radial styloid secondary to the strength of the radioscapholunate ligament. The first is from a direct blow on the dorsal surface of the wrist. These fractures are rarely displaced, but are high risk as they are always intraarticular. The fracture is typified by oblique fractures through the radial styloid process. More colloquially known by chauffeur fracture, as it was commonly seen in patients of this profession. Named after Jonathan Hutchinson (1821-1913), a British surgeon. The majority of Barton fractures will require ORIF, especially those that involve >50% of the articular surface.Ĭhauffeur Fracture (aka Hutchinson’s fracture) It is sometimes referred to as a type III Smith’s fracture. Volar Barton fractures result from a FOOSH onto a flexed wrist in pronation. 2 It results from a FOOSH with the wrist in extension and pronation. The volar type is more common than dorsal type.ĭorsal Barton fractures represent the most common fracture/dislocation of the wrist. The commonality in the two is that they are both fractures of the distal radius, through the joint space, and include dislocation of the overlying carpal bones with the fracture fragment. 1īarton fractures can either be displaced volarly or dorsally. Named after John Rhea Barton (1794-1871), who first described the injury pattern in 1838. Care should be taken when hyperflexing the wrist, as it can result in new and/or worsening median nerve damage.Ī long arm/double sugar-tong cast should be applied with the wrist in neutral position and the forearm in supination. Reduction is achieved with longitudinal traction with hyperflexion and return of the fracture fragment to anatomical position. It occurs as the result of forced flexion and pronation of the wrist during a FOOSH or, less commonly, after a direct blow to the dorsal surface of the wrist.Ĭommonly associated with acute carpal tunnel syndrome (characterized by paresthesia in the median nerve distribution) as well as carpal injuries. The fracture is typically volarly displaced and angulated. This fracture is often referred to as a reverse Colles’ fracture. Named after Robert William Smith after he described the fracture in A Treatise on Fractures in the Vicinity of Joints. Displaced fractures without satisfactory reduction should be seen urgently. Non-displaced fractures can be seen in orthopedic follow-up within 10 days. The position of immobilization is under debate however, the wrist should be kept in a position of function and slightly dorsiflexed and neutral. 2Ī sugar-tong or double sugar-tong splint should be applied. Reduction is achieved with longitudinal traction, over-exaggeration of the deformity (dorsiflexion), and replacement of the dorsally and proximally displaced fracture fragment into normal anatomic position. It is commonly associated with ulnar styloid process fractures, scapholunate dissociations, and injuries to the triangular fibrocartilage complex (TFCC). There is significant tension on the volar aspect of the radius and compression on the dorsal aspect. It occurs as a result of forced extension of the wrist, generally from a fall on an outstretched hand ( FOOSH). Originally described by Abraham Colles in 1814 after noticing a distinct fracture pattern in low energy injuries in elderly people, this fracture is typically dorsally displaced and angulated. Author: Jason Brown, MD (EM Resident Physician, University of Maryland) // Edited by: Alex Koyfman, MD (EM Attending Physician, UT Southwestern Medical Center / Parkland Memorial Hospital, and Brit Long, MD EM Chief Resident at SAUSHEC, USAF) ![]()
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