Wrist fractures

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.[1]Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am. 2007 Sep;89(9):2051-62. http://www.ncbi.nlm.nih.gov/pubmed/17768207?tool=bestpractice.com [2]Rutgers M, Mudgal CS, Shin R. Combined fractures of the distal radius and scaphoid. J Hand Surg Eur Vol. 2008 Aug;33(4):478-83. http://www.ncbi.nlm.nih.gov/pubmed/18687836?tool=bestpractice.com

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.