وخرد جان خداوند وخرد بنام جان خداوند بنام

Classification of distal Classification of distal radius fxradius fx

H.Saremi.MDH.Saremi.MD

Orthopaedic surgeon,upper limb surgery fellowshipOrthopaedic surgeon,upper limb surgery fellowship

Hamedan university of medical sciencesHamedan university of medical sciences

HAMEDAN,IRANHAMEDAN,IRAN

Distal radius fractureDistal radius fracture

in the time ofin the time of

Hippocrates Hippocrates

and Galen were and Galen were

thoughtthought

to be wrist dislocationsto be wrist dislocations

Pouteau first described DRF as a Pouteau first described DRF as a variety of forearm fractures in the variety of forearm fractures in the French literature. French literature.

Pouteau, C.: Oeuvres Posthumes dePouteau, C.: Oeuvres Posthumes de M Pouteau, Paris, P.D. Pierres, pp M Pouteau, Paris, P.D. Pierres, pp

251, 1783251, 1783

Colles, A.: On the Fracture of the Colles, A.: On the Fracture of the Carpal Extremity of the Radius. Carpal Extremity of the Radius. Edinburgh Med Surg, 10;182-186, Edinburgh Med Surg, 10;182-186, 18141814

Colles based his descriptions on Colles based his descriptions on clinical examinations alone, because clinical examinations alone, because X RAY was invented by Roentgen in X RAY was invented by Roentgen in

1899 . 1899 .

• DRFs are among the most common DRFs are among the most common type of fracturetype of fracture

• The most common fx seen in the The most common fx seen in the emergency departementemergency departement

• Bimodal distributionBimodal distribution• 18-25 years high-energy injuries18-25 years high-energy injuries• >65 years low-energy injuries>65 years low-energy injuries

Which classification?Which classification?

Frykman’s classificationFrykman’s classification

• 19671967• Useful,easy to learn,and communicate with Useful,easy to learn,and communicate with

colleguescollegues• NOT readily translate into prognostic or NOT readily translate into prognostic or

treatment utilitytreatment utility

Melone’s classificationMelone’s classification

• 19841984• Identified 4 major components Identified 4 major components • Attention on the medial(lunate)facetAttention on the medial(lunate)facet

AO classificationAO classification

• 1986 revised in19901986 revised in1990• Little interobserver agreement forr Little interobserver agreement forr

subdivisionssubdivisions

Rayhack’s classificationRayhack’s classification

• Intra or extra articularIntra or extra articular• Stable or unstableStable or unstable

Mayo clinic classificationMayo clinic classification

• Extra or intra articularExtra or intra articular• Reducible or irreducibleReducible or irreducible

Fragment-specific Fragment-specific classificationclassification

• MedoffMedoff• Intra articular fxIntra articular fx• 5 major fragments5 major fragmentsRadial styloidRadial styloidDorsal wallDorsal wallImpacted articular fragmentsImpacted articular fragmentsDorsal ulnar corner(Die punch fragment)Dorsal ulnar corner(Die punch fragment)Volar rim fragmentVolar rim fragment

Columnar classificationColumnar classification• RIKLI _REGAZZONIRIKLI _REGAZZONI• Radial or lateral columnRadial or lateral column

Length and alignment Length and alignment

Of the articular surfaceOf the articular surface• Intermediate columnIntermediate column

Primary load bearing Primary load bearing

Dorsal die punch,impacted intraarticular,volar ulnar cornerDorsal die punch,impacted intraarticular,volar ulnar corner• Medial columnMedial column

Fernandez classification Fernandez classification

• Mechanism of injuryMechanism of injury

Classification of DRUJ Classification of DRUJ injuriesinjuries

Observer agreementObserver agreement

• AO-----------adequate for the main typesAO-----------adequate for the main types• MYO---------moderateMYO---------moderate• Fair------------frykman,melone Fair------------frykman,melone

Aogroupes and subtypesAogroupes and subtypes