Distal radius fracture - Frykman type IV

Case contributed by Dinesh Brand
Diagnosis certain


Fall 5 weeks ago, tender radial styloid.

Patient Data

Age: 90 years
Gender: Male

Distal metaphyseal radial fracture with coexisting ulnar styloid fracture - Frykman type IV.
There appears to be a transverse fracture line. Separation of the articular surface by approximately 1.5 mm. The proximal articular surface of the radiocarpal joint is disrupted with a fragment that includes approximately 40% of the articular surface.

Erosion and reactive sclerosis on both sides of the 1st carpometacarpal joint (CMCJ). Erosions in all the proximal interphalangeal joints (PIPJ) and interphalangeal joint of the thumb. Periarticular osteophytes in all of said joints and the distal interphalangeal joints (DIPJ). Radiographic picture consistent with erosive osteoarthritis.

Case Discussion

The Frykman classification of distal radial fractures is based on the AP appearance. It assesses the pattern of fractures, involvement of the distal radioulnar joint and presence of an ulnar styloid fracture.

In this case, with the injury occurring 5 weeks ago, there is no appreciable callus formation and persisting lucency of fracture margins, suggestive of delayed fracture healing.

CT of the wrist would be of value in defining the extent of disruption of the distal radial articular surfaces.

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