Combined Fractures of the Distal Radius—Type V

Abstract

This group of fractures of the distal end of the radius includes those injuries made more complex by either the fracture pattern itself or by associated ipsilateral skeletal or soft tissue trauma, or those resulting from high-energy impact such as a fall from a height, automobile accident, crush trauma, or gunshot wound.^{2,7–9,17–19,21,32–34,37,41} Most often the fracture pattern is that of a complex intra- and extraarticular injury with comminution extending into the radial shaft. In some instances, however, the articular surface may be intact although the metaphysis has experienced massive comminution or bone loss, such as that which might occur from a gunshot wound. These fractures have a high incidence of associated soft tissue injuries, compartment syndrome, and ipsilateral fractures or dislocations of the upper limb (Fig. 9.1A-H).

On May 6, 1855, Catherine A, age 56, ran out of a public-house, where she had been drinking, and threw herself beneath the wheels of a passing cab. Her left wrist was crushed. Mr. Stanley amputated by double flaps, just below the elbow. On examining the forearm the muscles about the wrist were found to be greatly lacerted. Of the arteries, the ulna was torn across one inch above the pisiform bone. The nerves were uninjured. Both bones were extensively comminuted just above their carpal ends, and the fracture of the radius extended into the wrist joint. On the eleventh day she died from tetanus. G. W. Callender 1865