Contents
Complications of Wrist Fractures
- most common complications are poor grip strength, stiffness, & radial shortening
- distal radius fractures in individuals <40 years of age are usually highly comminuted & are likely to require ORIF
- 80% have normal function in 6-12 months
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Early |
Late |
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Colles Fractures
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PEARL
a Chauffeur’s # is an insolated radial styloid fracture |
Definition
- transverse distal radius fracture (about 2 cm proximal to the radiocarpal joint) with dorsal displacement ± ulnar styloid fracture
Epidemiology
- most common fracture in those >40 years, especially in women and those with osteoporotic bone
Mechanism
- FOOSH
Clinical Features
- “dinner fork” deformity
- swelling, ecchymosis, tenderness
Investigations
- characteristic findings on x-ray (see side image)
- # classifications: Frykman’s, Universal, Melone
Treatment
- goal is to restore radial height, radial inclination (22o) and volar tilt (11o)
- closed reduction (think opposite of the deformity)
-hematoma block (sterile prep & drape, local anesthetic injection directly into # site)
-closed reduction – traction with extension (exaggerate injury), then traction with ulnar deviation, pronation, flexion of distal fragment – not at wrist)
-dorsal slab/below elbow cast for 5-6 weeks
-x-ray q1 week to ensure reduction is maintained - obtain post-reduction films immediately – repeat reduction if necessary, consider external fixation or ORIF
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PEARL
a Barton’s # is a fracture-dislocation of the distal radius |
Smith’s Fracture
Definition
- volar displacement of the distal radius (i.e. reverse Colles’ fracture)
Mechanism
- fall onto the back of the flexed hand
Treatment
- usually unstable and needs ORIF
- if patient is poor operative candidate, may attempt non-operative treatment
- closed reduction with hematoma block (reduction opposite of Colles’)
- long-arm cast in supination x 6 weeks
Scaphoid Fracture
Epidemiology
- common in young men; not common in children or in patients beyond middle age
Mechanism - FOOSH resulting most commonly in a transverse fracture through the waist (middle) of the scaphoid
Clinical Features
- pain on wrist movement
- tenderness in scaphoid region (anatomical “snuff box”)
- usually undisplaced
Investigations
- x-ray (AP/lat/scaphoid views with wrist extended and ulnar deviation) q2 weeks
- ± bone scan
- ± CT
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PEARL
a fracture may not be radiologically evident up to 2 weeks after acute injury, so if a patient complains of wrist pain and has anatomical snuff box tenderness but a negative XR, treat them as if they have a scaphoid fracture. Consider obtaining a CT scan or have the patient return in 10-14 days for re-examination and repeat XR 2 weeks later to rule out a fracture. |
Treatment
- undisplaced = long-arm thumb spica cast x 4 weeks then short arm cast until radiographic evidence of healing is seen (2-6 months)
- displaced = open (or percutaneous) screw fixation
Complications
- delayed union
- non-union (must use bone graft to heal)
- AVN of the proximal fragment (since the scaphoid has distal to proximal blood supply, the more proximal the fracture, the greater the incidence of AVN)
- osteoarthritis
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PEARL
scapholunate advanced collapse (SLAC) is a specific pattern of osteoarthritis and subluxation which results from untreated chronic scapholunate dissociation or from chronic scaphoid non-union |
Prognosis
- fractures of the proximal third of the scaphoid have >40% rate of non-union or AVN
- waist fractures have healing rates of 80-90%
- distal third fractures have healing rates close to 100%
