Presentation
FOOSH injury. Query fractured wrist.
Patient Data
There is evidence of a recent fracture of the distal metaphysis of the radius and ulnar styloid.
The Frykman classification of distal radial fractures is based on the AP appearance.
There is a Frykman type VIII: transverse metaphyseal fracture of the distal radius (type VII plus ulnar styloid fracture).
Fracture 1 - distal radius: There appears to be a transverse fracture line. The fracture extends from the medial to the lateral cortex. There appears to be comminution of the fracture fragments. There is distraction of approximately 5 mm. The fracture margin extends to and involves the adjacent radio-ulnar articular cartilage surface. The proximal articular surface of the radio-carpal joint is disrupted with a fragment including approximately 20 % of the articular surface.
Fracture 2 - ulnar styloid: There appears to be a transverse fracture line. The fracture extends from the medial to the lateral cortex. There is distraction of approximately 1 mm. The articular surfaces are intact.
Case Discussion
The Frykman classification of distal radial fractures is based on the AP appearance. It assesses the pattern of fractures, involvement of the radioulnar joint and presence of a distal ulnar styloid fracture.
This complex case involves a comminuted fracture with involvement of both the radiocarpal and radioulnar joints (type VII) and an accompanying ulnar styloid fracture classifying the complete fracture as a Frykman type VIII distal radial fracture.
As with other Frykman type distal radial fractures, CT of the wrist would be of value in defining the extent of disruption of the distal radial articular surfaces. An orthopedic review is recommended for the possibility of an ORIF.
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