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SAQ 339 – Orthopaedics – distal radius fracture and Bier block

Review Completed

Marked out of 12.00

A 35-year-old man falls down several steps onto his outstretched right hand. He has an isolated right wrist injury. X-rays are shown below.

AP and lateral right wrist X-rays showing distal radius fracture with dorsal angulation. — Right wrist X-rays

Outline four (4) radiographic abnormalities.

(Marked out of 4.0)

/ 4

Other than neurovascular compromise, list four (4) indications for closed reduction, including targets.

(Marked out of 4.0)

/ 4

List four (4) contraindications to Bier block.

(Marked out of 4.0)

/ 4

Total Score: 0 / 12

Percentage: 0%

Model Answer

Orthopaedics – distal radius fracture and Bier block.

a. X-ray abnormalities

Extra-articular distal radius fracture.
About 25% posterior displacement.
About 45 degrees dorsal angulation.
Minimally displaced ulnar styloid fracture.

b. Reduction indications/targets

Radial height shortening more than 5 mm.
Change in radial inclination more than 5 degrees.
Articular incongruity or step-off greater than 2 mm.
Dorsal angulation greater than 5 degrees, or more than 20 degrees compared with the contralateral distal radius.

c. Bier block contraindications

Local anaesthetic allergy.
Severe hypertension, for example BP greater than 200 mmHg.
Methaemoglobinaemia.
Cuff cannot fit or seal reliably, such as small child or morbid obesity.
Uncooperative patient.
Lymphoedema, Raynaud disease, or peripheral vascular disease.

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