![]() ![]() Angles should be within the same parameters for acceptable angulation. Angulation in the coronal plane (as seen on AP x-ray) is less tolerated as it does not remodel as well as angulation in the sagittal plane (as seen on the lateral x-ray). Fractures angulated more than these values usually need to be reduced. Table 1 shows the acceptable angulations for distal radius metaphyseal fractures. When is reduction (non-operative and operative) required?Īs a rule of thumb, if the deformity is clinically visible, reduction may be indicated.Īcceptable angulations are dependent on the age of the child. Most metaphyseal fractures displace posteriorly. it is a complete fracture).įigure 3: AP and lateral x-ray of 15 year old with complete metaphyseal fracture of radius and ulna. However on the AP view, it shows that both cortices are broken (i.e. On the lateral view, there is a minimally displaced radial metaphysis, which could be mistaken for a buckle fracture. These fractures are potentially unstable and need to be managed in a well moulded cast.įigure 2: Six year old with complete metaphyseal fracture. Minimally displaced complete metaphyseal fractures can be mistaken for buckle injuries (Figure 2). Bilateral or unicortical cortical bulging can occur. They are best viewed on the lateral x-ray. Buckle injuries are often subtle radiographically. What do they look like on x-ray? Buckle injuryįigure 1: Lateral and AP x-ray of a five year old who sustained a buckle injury of the distal radius. If there are any elbow joint symptoms, an 'elbow x-ray' should be ordered as some fractures around the elbow can be difficult to detect. Avoid ordering 'x-ray arm' as it is better to have images focused to the region of local tenderness. If the injury is to the mid forearm or the pain is poorly localised, a 'forearm x-ray' should be ordered. What radiological investigations should be ordered?Ī 'wrist x-ray' request will provide AP and lateral views of the distal forearm and wrist. An x-ray of the wrist should be ordered to clarify the diagnosis. Buckle injuries are often misdiagnosed as a wrist sprain. Buckle injuries present with no or minimal deformity. There is usually pain and tenderness directly over the fracture site, and limited range of motion in the wrist and hand.ĭeformity depends on the degree of fracture displacement. These injuries can occur in conjunction with more proximal forearm fractures, such as Monteggia fracture-dislocations, supracondylar humeral fractures and hand fractures. Volar (anterior) displacement of the distal fragment is usually the result of a fall on a flexed wrist. Extension of the wrist at the time of injury causes the distal fragment to be displaced dorsally (posteriorly). The most common mechanism of injury is a fall on an outstretched hand. Up to 13% incidence of other arm injuries (hand, forearm, elbow) occur on the same side. ![]() Metaphyseal fractures have a peak incidence during the adolescent growth spurt (girls aged 11-12 years, boys 12-13 years) due to weakening through the metaphysis with rapid growth. How common are they and how do they occur? The ulna may have a complete fracture, greenstick fracture, or a plastic deformityģ. The radius is commonly a complete fracture. Most complete metaphyseal fractures involve both the radius and ulna. See fracture education module for more informationĬomplete: A fracture that extends through both cortices. Although there is a disruption to the cortical bone, the integrity of the bone is minimally compromised, resulting in different patient management from other fractures bone involvement (radius only, both radius and ulna)īuckle injury: Compression injury failure of bone resulting in the cortex bulging outwards (unilateral or bilateral).displacement (whether undisplaced or displaced).No follow-up by GP or fracture clinic is required.Ĭomplete - undisplaced or minimally displaced fracturesĬlosed reduction with immobilisation in below-elbow cast for 6 weeksįor young children, above-elbow casts may be appliedĭistal radius metaphyseal fractures can be classified according to: Provide parent with buckle injury fact sheet. What are the potential complications associated with this injury?īelow-elbow fibreglass/plaster backslab or removable wrist splint for 3 weeksĬheck that both cortices are intact on the anteroposterior (AP) and lateral x-ray.What is the usual ED management for this fracture?.Do I need to refer to orthopaedics now?.When is reduction (non-operative and operative) required?.What radiological investigations should be ordered?.How common are they and how do they occur?.Distal radius and / or ulna metaphyseal fractures - Fracture clinics ![]()
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