Thanks for joining me
on this discussion of classic fractures
in the section of orthopedic surgery.
It’s important to know
that we won’t be covering every
single fracture known to orthopedic surgery,
just the high-yield information.
Let's begin with Colles' fracture.
Colles' fracture is a wrist fracture.
And the mechanism of action
is usually due to a fall
on an outstretched hand.
You can imagine a scenario,
an elderly patient
who is a little unsteady on their feet,
walking about with a cane.
As they fall,
it's natural reflex for us to
have our hands stretched out.
And this is on physical
examination, the finding.
What you’ll notice is that
it’s a fracture of the distal radius and ulnar
just above the wrist.
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.
Let's get some imaging.
Here are plain x-rays.
And you’ll notice on the circled areas
are where we see a distal radius
or ulnar fractures.
you can imagine why this would
happen in an outstretched hand.
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.
Let me pose a question to you.
Now that we’ve reviewed a Colles’ fracture,
what is a reverse Colles’ fracture?
I’ll give you a second
to think about this.
Instead of falling with an extended hand,
it is associated with a fall
on a flexed hand.
So instead of an extended hand,
we now have the fall
on the flexed hand,
but still landing on the wrist area.
This is still a high impact –
direct impact to the wrist.
Similarly, you can get the
ulnar or the radius fracture.
How do we fix it?
Well, it may require surgery
or they can simply be splinted
and immobilized for four weeks.
before orthopedic surgery
became a specialty of medicine
and in old times,
people used to heal all the time.
Our bones actually have
amazing ability to heal.
Let's move on.
This is called the
snuff box fracture.
A snuff box fracture is important.
It also is due to a fall
on an outstretched hand,
causing extreme dorsiflexion
and forced to load on the scaphoid bone.
On physical examination,
notice the triangle demonstrating the snuff box.
This is called the anatomic snuff box.
Tenderness over this anatomic region
is suggestive that there
may be a snuff box fracture.
There may also be associated
bruising or swelling.
if you can see it on the x-ray,
the green arrow points to the snuff box
or scaphoid fracture.
sometimes it’s difficult to detect
these fractures on plain x-rays alone.
And that's why orthopedic
surgeons often get an MRI.
These MRIs may help
detect an injury earlier.
And for snuff box injuries,
detection is better for outcomes.
How do we fix it?
Well, surgery is usually not recommended.
It's generally a thumb splint
and don't forget to reimage
several weeks later.
In fact, for all fractures,
usually, we recommend follow-up x-rays
to make sure things are healing
and healing in an aligned fashion.