Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- wrist pain
- tenderness over the distal radius
- swelling
Other diagnostic factors
- deformity
- tenderness in the anatomic snuff-box
- numbness in the fingers
- hypo-aesthesia
- open wound
Risk factors
- trauma
- osteopenia
- osteoporosis
Diagnostic investigations
1st investigations to order
- plain x-rays of the wrist
Investigations to consider
- CT wrist
- MRI (without contrast) wrist
Treatment algorithm
isolated fracture of distal radius
isolated scaphoid fracture
concomitant distal radius and scaphoid fractures
confirmed wrist fracture
Contributors
Expert advisers
Michael Barrett, MBChB, FRCS (Tr & Orth), PG Cert Med Ed
Consultant Trauma and Orthopaedic Surgeon
Cambridge University Hospitals NHS Foundation Trust
Cambridge
UK
Disclosures
MB is a director of Orthohub.xyz, an online education platform for orthopaedic surgeons. Orthohub.xyz receives sponsorship from the healthcare industry.
Acknowledgements
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
Maasstad Hospital
Rotterdam
Netherlands
Disclosures
NWLS is an author of several references cited in this topic. He is a consultant for Synthes, Medartis, and Arthrex, and has received honoraria from The AO Foundation for teaching courses.
Peer reviewers
Ramon Tahmassebi, MBBS, BSc (Hons), FRCS (Tr & Orth)
Consultant Trauma & Orthopaedic Surgeon
Clinical Director Trauma & Orthopaedic Surgery
King's College Hospital NHS Foundation Trust
London
UK
Disclosures
RT declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
British Society for Surgery of the Hand; British Orthopaedic Association. Best practice for management of distal radial fractures. 2018 [internet publication].Full text
National Institute for Health and Care Excellence. Fractures (non-complex): assessment and management. February 2016 [internet publication].Full text
British Orthopaedic Association. British Orthopaedic Association Standard for Trauma (BOAST): the management of distal radial fractures. December 2017 [internet publication].Full text
British Orthopaedic Association. British Orthopaedic Association Standard for Trauma (BOAST): early management of the paediatric forearm fracture. May 2021 [internet publication].Full text
National Institute for Health and Care Excellence. Fractures (complex): assessment and management. November 2022 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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