Case #3

Case #1

• Acute comminuted, impacted, transverse distal radial metaphyseal fracture with mild volar displacement, volar angulation of the distal radial articular surface, and extension into the radiocarpal joint
• Acute mildly comminuted, minimally displaced spiral fracture of the distal ulna
• Acquired ulnar positive variance
• Mild degenerative changes of the first MCP joint and involving many of the carpal joints

• Smith fracture (Frykman IV)

• Distal radial fractures can often be referred to as one of the following 3 eponyms:
  • Colles fracture – a transverse fracture with dorsal tilt of the distal radial articular surface. May have associated impaction and/or intraarticular extension
    • Some reserve this term only for fractures that do not have intraarticular extension
  • Smith fracture – a transverse fracture with volar tilt of the distal radial articular surface. May have associated impaction and/or intraarticular extension
  • Barton fracture – an obliquely-oriented intraarticular distal radial fracture that may result in an articular surface step-off
    • Technically a Barton fracture involves the dorsal articular surface. If the fracture involves the volar surface, it is referred to as a reverse Barton fracture
• A commonly used classification system for distal radial fractures is the Frykman classification, which is based of the appearance of fractures on AP radiographs alone:
  • Type I: extraarticular transverse metaphyseal fracture
  • Type II: type I with an ulnar styloid fracture
  • Type III: distal radial fracture extending into the radiocarpal joint
  • Type IV: type III with an ulnar styloid fracture
  • Type V: transverse fracture involving the distal radioulnar joint, but not the radiocarpal joint
  • Type VI: type V with an ulnar styloid fracture
  • Type VII: comminuted fracture involving both the distal radioulnar and radiocarpal joints
  • Type VIII: type VII with an ulnar styloid fracture
• Make sure to also look for ulnar positive variance when you see an impacted radial fracture, as this can lead to long-term morbidity

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