Classic Fractures

00:01 Welcome back.

00:02 Thanks for joining me on this discussion of classic fractures in the section of orthopedic surgery.

00:08 It’s important to know that we won’t be covering every single fracture known to orthopedic surgery, just the high-yield information.

00:17 Let's begin with Colles' fracture.

00:20 Colles' fracture is a wrist fracture.

00:23 And the mechanism of action is usually due to a fall on an outstretched hand.

00:28 You can imagine a scenario, an elderly patient who is a little unsteady on their feet, walking about with a cane.

00:35 As they fall, it's natural reflex for us to have our hands stretched out.

00:42 And this is on physical examination, the finding.

00:46 What you’ll notice is that it’s a fracture of the distal radius and ulnar just above the wrist.

00:51 Clearly, the hand here and the upper wrist looks like there is obvious deformity and there's some swelling in the region of the distal writst.

01:03 Let's get some imaging.

01:04 Here are plain x-rays.

01:06 And you’ll notice on the circled areas are where we see a distal radius.

01:11 Once again, you can imagine why this would happen in an outstretched hand.

01:15 And it's also important, as you can see, based on these x-rays, the radius and the ular are not the biggest, strongest bones.

01:25 Let me pose a question to you.

01:28 Now that we’ve reviewed a Colles’ fracture, what is a reverse Colles’ fracture? I’ll give you a second to think about this.

01:36 That’s right.

01:37 Instead of falling with an extended hand, it is associated with a fall on a flexed hand.

01:42 So instead of an extended hand, we now have the fall on the flexed hand, but still landing on the wrist area.

01:48 This is still a high impact – direct impact to the wrist.

01:52 Similarly, you can get the ulnar or the radius fracture.

01:58 How do we fix it? Well, it may require surgery or they can simply be splinted and immobilized for four weeks.

02:06 Remember, before orthopedic surgery became a specialty of medicine and in old times, people used to heal all the time.

02:13 Our bones actually have amazing ability to heal.

02:19 Let's move on.

02:20 This is called the snuff box fracture.

02:23 A snuff box fracture is important.

02:25 It also is due to a fall on an outstretched hand, causing extreme dorsiflexion and forced to load on the scaphoid bone.

02:37 On physical examination, notice the triangle demonstrating the snuff box.

02:41 This is called the anatomic snuff box.

02:44 Tenderness over this anatomic region is suggestive that there may be a snuff box fracture.

02:50 There may also be associated bruising or swelling.

02:56 On imaging, if you can see it on the x-ray, the green arrow points to the snuff box or scaphoid fracture.

03:04 However, sometimes it’s difficult to detect these fractures on plain x-rays alone.

03:11 And that's why orthopedic surgeons often get an MRI.

03:17 These MRIs may help detect an injury earlier.

03:21 And for snuff box injuries, detection is better for outcomes.

03:28 How do we fix it? Well, surgery is usually not recommended.

03:32 It's generally a thumb splint and don't forget to reimage several weeks later.

03:37 In fact, for all fractures, usually, we recommend follow-up x-rays to make sure things are healing and healing in an aligned fashion.