Wrist fractures affecting the distal radius are the most common fracture in adults and children and are typically caused by a fall on the outstretched hand.
This injury may be accompanied by fractures of the ulnar styloid, the distal ulna, and the scaphoid. Isolated scaphoid fractures can also occur and should be considered in the differential of a patient with radial-sided wrist pain after a fall on their hand.
Non-displaced fractures do not have any deformity and are treated with immobilisation in a splint or cast.
Displaced fractures usually present with a 'dinner fork' deformity and require closed reduction and possible surgical fixation. Successfully reduced fractures can be treated non-surgically with immobilisation and radiographic monitoring.
Malunion of inadequately reduced fractures may result in decreased range of motion and grip strength, as well as pain, in younger patients, who may place a higher demand on the wrist.
Purely ligamentous injuries can be a cause of wrist pain after a fall on an outstretched hand in the setting of normal radiographs.
Wrist fractures include fractures that affect the distal ends of the radius, ulna, and carpus. Distal radius fractures are one of the most common injuries. The distal radius is defined as the distal one third of the radius. Distal radius fractures may be extra-, intra-, or partial articular and are regularly accompanied with an ulnar styloid fracture.
Fractures associated with a radiographic appearance that is essentially normal with respect to extra- and intra-articular anatomy are considered non-displaced. All other fractures - that is, all fractures with loss of anatomical contours - are considered to be displaced. Clearly, all displacements are not the same and some fractures are associated with greater anatomical deformity than others. Fractures associated with an open wound are considered open fractures.
History and exam
Key diagnostic factors
- presence of risk factors
- wrist pain
- tenderness over the distal radius
Other diagnostic factors
- tenderness in the anatomic snuff-box
- numbness in the fingers
- open wound
1st investigations to order
- plain x-rays of the wrist
Investigations to consider
- CT wrist
- MRI (without contrast) wrist
isolated fracture of distal radius
isolated scaphoid fracture
concomitant distal radius and scaphoid fractures
confirmed wrist fracture
Michael Barrett, MBChB, FRCS (Tr & Orth), PG Cert Med Ed
Consultant Trauma and Orthopaedic Surgeon
Cambridge University Hospitals NHS Foundation Trust
MB is a director of Orthohub.xyz, an online education platform for orthopaedic surgeons. Orthohub.xyz receives sponsorship from the healthcare industry.
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:
Niels W.L. Schep, MD
Trauma, Hand, and Wrist Surgeon
Department of Trauma and Hand Surgery
Ramon Tahmassebi, MBBS, BSc (Hons), FRCS (Tr & Orth)
Consultant Trauma & Orthopaedic Surgeon
Clinical Director Trauma & Orthopaedic Surgery
King's College Hospital NHS Foundation Trust
RT declares that he has no competing interests.
Section Editor, BMJ Best Practice
EQ declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
RW declares that she has no competing interests.
Drug Editor, BMJ Best Practice
AM declares that he has no competing interests.
Comorbidities Editor, BMJ Best Practice
JC declares that she has no competing interests.
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