Episode 3: Distal Radius Fractures

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Casting: the junior Ortho Pod

Ajay Shah

18 episodes

2 days ago

Casting is the Orthopaedic Surgery podcast for senior medical students and junior residents. Hosted by Ajay Shah (PGY-1, University of Toronto), featuring conversations with residents and faculty on a wide range of topics, including an evidence-based approach to common Orthopaedic Surgery injuries, medical education and innovation, and tips and tricks for survival and improvement during the trenches of a surgical residency.

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Episode 3: Distal Radius Fractures

Casting: the junior Ortho Pod

26 minutes 27 seconds

4 years ago

Episode 3: Distal Radius Fractures

I had a great chat with Dr. Adrian Huang, an upper extremity surgeon at UBC (@scrubbedout) about distal radius fractures. We talked about the optimal closed reduction and casting maneuvers, common fracture patterns based on the anatomy, and a neat intra operative technique to maximize exposure without injuring the median nerve. Find some awesome content on his website and social media:

IG: instagram.com/scrubbedout/

Website: scrubbedout.com

1:15-3:45 - Definition of “distal radius fracture”, epidemiology, identification in polytrauma/comatose pt

3:45-6:00 - Anatomy of DR, osteology, joints, patterns; that unstable lunate facet - https://doi.org/10.2214/ajr.13.12140

6:15-8:35 - Extra-articular DR fracture management, 5 criteria for ORIF, post-reduction films, critical volar cortex component; https://www.orthobullets.com/trauma/1027/distal-radius-fractures “ORIF Indications”

8:35-16:00 - Closed reduction maneuvers; hematoma block, finger traps, casting technique, common complaints, 1st web space, out to MCPs, distal to elbow crease, hinge at fracture (not wrist)

16:00-16:45 - Smith fractures, reverse molds, median n, close followup

18:00-19:00 - Indications for ORIF are multifactorial; https://www.scrubbedout.com/distalradiuscheatsheet

19:00-23:00 - Modified approach per @scrubbedout; https://www.instagram.com/p/CIZgdXyB35h/ has less median n stretch, Orbay approach; https://doi.org/10.1097/00130911-200112000-00004 . Cover hardware with PQ/BR to reduce need for removal

23:00-26:15 - Avoid damaging NV by not using sharp/self retainers, always fix what you remove (eg: RC ligaments), don’t miss associated injuries (eg: scaphoid/lunate)

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