colles fx: volar or dorsal angulation

[corona 247]

I have read different answers from different texts (unless I am missing something). Is it volar or dorsal!

Thanks!

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[Tired]

You're missing something.

Dorsal angulation. Or apex volar.

 

[corona 247]

could you explain a little more about the difference between dorsal angulation and volar apex.

My understanding is angulation is defined by which way the angle apex points. and therefore a dorsal angulation would have the apex angle point dorsally. Could you help me better understand?

Thanks! appreciate it

 

[SOUNDMAN]

You're missing something.

Dorsal angulation. Or apex volar.

What Tired said...the concept of apex volar angulation I find easier to show and draw then describe with words...it's just a different concept

 

[Tired]

Ironically, the best description I found of this was in a Radiology text.

From Juhl's Essentials of Radiologic Imaging:

"When describing displacement of fracture fragments, it is customary to refer to the displacement of the distal fragment in relation to the proximal, the latter being considered as the stationary part. Therefore, one speaks of a posterior displacement of the distal fragment of the tibia in relation to the proximal fragment rather than an anterior displacement of the proximal in relation to the distal. The same method is used in describing dislocations, the distal portion of the extremity being considered to be the dislocated part. For example, all dislocations of the elbow joint are displacements of the bones of the forearm on the humerus. In describing angular deformity, the distal fragment should be considered as being angled in relation to the proximal fragment. Therefore, a fracture of the distal tibia with lateral displacement of the foot would be described as lateral angulation of the distal fragment. As an alternative, the angulation may be defined at the fracture site. In the case described with lateral displacement of the foot, there would be medial angulation at the fracture site. The more common method is to describe the angulation of the distal fragment. Apposition, overlap or overriding, and number of fragments are other important observations."

Or, since I'm not too smart, I think of it like this: The "angulation" is the direction that the distal aspect of the distal fragment is pointing.

 

[SOUNDMAN]

ooo I like that, it beats me drawing on the board and beating it into peoples heads...I'll be using that from now on

 

[Tired]

ooo I like that, it beats me drawing on the board and beating it into peoples heads...I'll be using that from now on

The ironic part was that I couldn't find anything about this in Wheeless, Rockwood, Chapmans, or Koval. Yet it was bashed into my head from the moment I started interacting with the 'pods. Weird.

 

[corona 247]

ok, good, i got it now.

Thanks!!

 

[SOUNDMAN]

The ironic part was that I couldn't find anything about this in Wheeless, Rockwood, Chapmans, or Koval. Yet it was bashed into my head from the moment I started interacting with the 'pods. Weird.

Yep the first orthopod I worked for beat this into my head until I understood it, and described everything via apex angulation...the second one I worked for not so much...but I understand the head beating.

 

[medstudent33]

Sorry to bump this thread but I am still a little confused by this topic. I thought I understood what Soundman and Tired were saying with the Colles fractures how the angulation is opposite the direction of the apex (dorsal angulation and volar apex). This rule would also apply to a tibial fx with the foot laterally displaced as the apex is medial and there is later angulation. It confuses me however when trying to describe a Monteggia using Bado classification. In a type I it is supposed to have "anterior angulation." From looking at the xray the apex is anterior and the distal part of the distal fragment of the fracture is posterior when compared to the proximal fragment. Using the rules above this does not make sense and I would classify it as "posterior angulation." I know as an alternative, the angulation may be defined at the fracture site. How do you know if you are supposed to define it at the apex or by the distal piece of the distal fragment. If anyone can explain this to me I would greatly appreciate it.

 

[OrthoPathic]

I think the safe bet is to describe it as "displacement" when you're describing it at the apex or the fracture site. So I would say Dorsal displacement of the distal fragment, and if you use the term angulation, it's best to go with whichever the fragment is POINTING. So for a monteggia, you would have posterior displacement, and volar angulation. Not sure if that helps.

 

[TOcho118]

The distal fragment is angulated dorsally (which makes the apex of the fracture volar). Think about it like you're holding a pencil at both ends. Pull the distal hand up - the pencil will begin to bend (i.e. angulate) upward (dorsally), however once it breaks, the apex of the broken pencil will be pointing down (volar).

 

[medstudent33]

The distal fragment is angulated dorsally (which makes the apex of the fracture volar). Think about it like you're holding a pencil at both ends. Pull the distal hand up - the pencil will begin to bend (i.e. angulate) upward (dorsally), however once it breaks, the apex of the broken pencil will be pointing down (volar).

Still a little confused by the explaination. If it bent upward wouldnt that be volar angultion not dorsal?

How would you describe this fracture and what would be your reasoning behind it.

 

[hanky1982]

Still a little confused by the explaination. If it bent upward wouldnt that be volar angultion not dorsal?

How would you describe this fracture and what would be your reasoning behind it.

I think you are missing the concept of the Bado classification. It's with reference to the radius. So a monteggia type 1 is with an anterior dislocated radial head. Usually the apex of the ulna is in the same direction as the radial dislocation. Thus for a type 1: it is an anterior radius dislocation, apex anterior ulna which is angulated posterior. Hope that helps. The classification is in reference to the direction of the radius and not ulna with regards to Bado.

 

[TOcho118]

^as above. Type 1 is an anterior dislocation of the radial head. I agree that some of the nomenclature is confusing though. Just remember that when talking about fractures, things like angulation and displacement typically refer to the distal fragment relative to the proximal fragment.