Chauffeur Fracture - Causes, Symptoms, Diagnosis, and Management

Introduction

The forearm consists of two large bones: the radius and the ulna. The radius bone is thicker and is the largest bone, whereas the ulna is the longest bone. The radius bone lies parallel to the ulna and pivots around it to produce movements. The proximal surface of the radius bone articulates with the ulna to form the radioulnar joint. The distal surface of the radius bone articulates with the scaphoid and lunate bones to constitute the wrist joint or the radiocarpal joint. The distal radius has five surfaces; the lateral, medial, posterior, anterior, and the distal articular surface. The lateral surface of the radius bone projects to form a styloid process, and the oblique fracture of this radial-styloid process is called the Chauffeur fracture.

What Is Chauffeur Fracture?

A fracture of the pointed tip at the end of the radius bone (distal radius) is known as a Chauffeur fracture. It is an intraarticular fracture, as it extends into the wrist joint. It is also called a Hutchinson fracture, radial styloid fracture, or backfire fracture. It is a common orthopedic injury usually seen in young and active individuals, mostly males, and in elderly people, mainly females, with osteoporosis or low bone density.

Why Is It Called Chauffeur fracture?

It was first termed by a French orthopedic surgeon Just Lucas Championniere who evidenced an occupational injury of the wrist. This fracture was named so because of an increased incidence in chauffeurs or cab drivers after the invention of automobiles, which were to be started by clockwise rotation of a crank handle connected to the engine. Sometimes the crank handle would jerk back, resulting in wrist injury, ligament tearing, and hyperextension.

What Are the Causes of Chauffeur Fracture?

The fracture occurs due to compression of the scaphoid bone against the styloid process of the radius and may be associated with stretching of the ligaments, leading to avulsion.

Some of the causes of Chauffeur fractures include:

• A blow to the back of the wrist.

• Injuries caused due to high velocities like motor accidents and sports injuries.

• Direct trauma to the wrist, like a fall on an outstretched hand (FOOSH).

• Elderly people with osteoporosis are prone to wrist fractures.

What Are the Signs and Symptoms of Chauffeur Fracture?

Signs and symptoms include:

• Severe pain and bruises around the wrist joint.

• Presence of swelling and tenderness on palpation.

• Inability to move the joint or limited range of motion.

• Unusual bump or deformity or twisted joint.

How Is Chauffeur Fracture Diagnosed?

A complete medical history is taken, followed by a physical examination in which the doctor inspects to see any lacerations or cuts during the injury; palpation is done to check the areas of tenderness and also checks the pulse rate to ensure a good blood flow to the arm, checks the range of motion and neurological involvement. Radiological investigations include:

• X-rays to determine the location, number, and associated dislocation, X-rays are recommended. It also helps diagnose bony irregularities and radial length compared to the unaffected wrist.

• Computed tomography or CT Scan or magnetic resonance imaging (MRI), which provides a three-dimensional view, is preferred because it confirms the diagnosis and detects the associated soft tissue injuries.

How Is Chauffeur Fracture Managed?

The goal of Chauffeur fracture treatment is to stabilize the radius bone and restore the length and alignment along with the integrity of the surrounding soft tissues. Chauffeur fractures can be treated by both conservative and surgical methods. It depends on the severity, associated injuries, age, and activity level of the patient. Nonsurgical methods include:

• Closed Reduction: It is indicated in minor fractures or in cases of fractures that do not extend into the joint (extra-articular fractures) or in cases of shortening of the radius bone that is less than five mm (millimeter). The orthopedician realigns the bones back to their place and immobilizes the wrist with a plaster cast or a splint for around four to six weeks, followed by physical exercise therapy.

• Open Reduction and Internal fixation (ORIF): Limited open reduction and external fixation are followed in cases where the displacement is less than two mm, and external fixation is done using metal pins; open reduction is indicated in cases of severe fractures or cases associated with dislocation and soft tissue involvement. An incision is made on the volar part or the anterior part of the wrist, and the bone is exposed. The area is thoroughly cleaned, and the bones are repositioned to their normal alignment. Immobilization is done with the help of wires, screws, pins, and metal plates, and the incision is closed by sutures or staples, followed by splint fixation for four to six weeks, which provides support and stabilization. Medications, such as Ibuprofen, Acetaminophen, etc., are prescribed to relieve pain and swelling.

• Physiotherapy: It is advised to restore the range of motion, prevent stiffness and strengthen the muscles. Regular monitoring is done by X- rays in between the recovery period to avoid further complications.

What Are the Complications of a Chauffeur Fracture?

Complications of Chauffeur fracture include:

• Fractures or dislocation of the other bones that support the forearm, like the ulnar or scaphoid bones.

• Extreme stretching of the associated ligaments.

• Surrounding nerves and blood vessels can be injured.

• Improper healing or malunion of the fracture.

• Recurrence of pain and stiffness of joints.

• Carpal tunnel syndrome can occur due to compression of the median nerve, resulting in numbness or tingling sensation and weakness.

• Inflammation of the joints following a trauma (post-traumatic arthritis).

• Compartment syndrome can occur due to increased pressure in and around the muscles.

• Complex regional pain syndrome occurs due to nerve inflammation and dysfunction.

How to Reduce the Risk of Chauffeur Fracture?

• Maintaining a healthy lifestyle through proper diet and regular exercise.

• Regular use of calcium and vitamin D supplements in case of osteoporosis.

• Grab bars can be installed in bathrooms and railings in case of stairs.

• Avoiding slippery surfaces or wearing appropriate footwear.

• Wearing wrist guards during sports activities like football, rugby, snowboarding, and skating.

Conclusion

Chauffeur fracture is a break or discontinuity of the styloid process of the radius bone, which usually results from high-velocity trauma or a fall on an outstretched hand. It is associated with pain, swelling, stiffness, and unusual wrist deformity. It can be treated successfully by conservative or surgical procedures, along with medications and a healthy lifestyle.