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Barton vs colles fracture11/24/2023 ![]() For shortening to be described you look at the AP film. It should, in its typical anatomical position, be placed distal to it. So how short is short? Invariably the radial styloid distal point will be at the same level as the ulna styloid with a distal radial fracture. If the fracture is dorsally angulated you describe that angulation The C-Radial line should point down the shaft of the 1st metacarpal (approximately). Also on the lateral view, drawĪ line along the shaft of the 1st metacarpal. ![]() So how angulated is angulated? Well, draw a line across the C shape of the joint surface of the radius (on the lateral view) and run a perpendicular off from that line. When bones break during falls on outstretched hands invariably they give/fracture at one point. ![]() Hopefully the X-ray confirms your clinical suspicions. Think efficiency of the X-ray department: you waste a finite resource if the patient has to return for better images because the initial analgesia wasn’t sufficient, and that slows the functioning of the ED. Inadequate analgesia gives you inadequate images which means inadequate management. You need to achieve a state of analgesia where the patient is comfortable and able to move their wrist onto the x-ray plates, which is the next stage of the radial fracture pathway. If necessary give IV analgesia and of course apply a ( elevation) sling.Įarly use of inhaled analgesia: Penthrox or Entonox – allows for better images, rotated images affect the standard of fracture angulation measurement and xrays are sore to get right. Start with something that works immediately in the analgesia timeline: nasal diamorphine or fentanyl or inhaled agents such as Entonox or Penthrox. Oral analgesia is probably not going to help in the first hour, maybe oramorph works in 15 to 30 mins but oral analgesia should form a midpoint of the analgesic timeline. I like to think about a ‘timeline of analgesia’. Younger people will have a more marked mechanism of injury and the elderly a low energy mechanism of injury that suggests skeletal fragility.ĭocument neuro-vascular status, side of dominance and profession.ĭon’t forget to remove any rings or watches from the affected side (and pop them on the unaffected side so they don’t get lost). It’s painful, it presents acutely! And as Abraham Colles described, the wrist looks like a dinner fork, caused by dorsal swelling (caused by the distal fragment and local haematoma). This blog won’t talk about falls or mechanism other than say FOOSH: fell on outstretched hand. How will we stop it happening again (including her ability to manage with the injuries she has…) What injuries has she sustained other than the wrist fracture?ģ. Also solves the apostrophe problem.Ĭontrary to this, wikipedia says colles’ so I’ll change my mind! So let’s just be simple, we’re talking about a, distal radial fracture with dorsal angulation. Everything else is a distal radial fracture or a Smiths or a Bartons or a Chauffeur fracture or Galeazzi. The eponymous fracture is a dorsally angulated extra-articular distal radial metaphyseal single segment fracture. Author: The collective twitter wisdom, but mostly Dr Rob Greig / Editors: Charlotte Davies, Liz Herrieven / Codes: C3AP2b, HAP19, SLO1, SLO4, TP7 / Published: Ĭolles’ fractures are a common presentation to emergency departments across the globe.
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