Pearls
- Fracture of the joint’s rim that leads to instability. Generally require surgery.
- Appearance is similar to Colle or Smith fracture, but has intra-articular involvement.
- Can cause either volar or dorsal displacement.
Reduction Goals
Adults:
- Length: <5mm of shortening
- Volar/Palmar Tilt: <5° dorsal angulation or within 20° of the other wrist
- Step off: <2mm
- Radial Inclination: <5° change
Normal wrist anatomy:
- 11° of volar tilt
- 23° of radial inclination
- 13mm radial height
Pediatrics:
- Salter-Harris II: Up to 15° of angulation and 1 cm of shortening will generally remodel. Remodeling has been estimated to be 10° of angulation per year of remaining growth.
Pediatric patients can be placed in a bivalved cast (long arm or short arm) if expertise is available.
Reduction Tips:
Apply longitudinal traction and then "recreate" the injury by accentuating the deformity before applying dorsal or volar pressure to reduce the fracture.