MANUAL MINORS
Avulsion fractures of the carpal bones occur when a bone fragment is pulled away due to excessive traction from a ligament or tendon on the bone. These fractures are typically the result of indirect trauma, such as falls onto an outstretched hand or forced movements. The most commonly affected carpal bones are the scaphoid and the triquetrum.
Diagnosis
The diagnosis is based on:
Acute, localised pain in the affected carpal area, usually following a fall or trauma.
Swelling and tenderness over the specific bone.
Limited wrist movement, especially during flexion and extension.
X-rays are essential to visualise the avulsed bone fragment. In some cases, avulsion fractures can be difficult to detect on standard X-rays, so CT scans may be required for better evaluation.
Differential Diagnosis
Condition | Key Differences |
---|---|
Wrist Sprain | Pain and swelling without a visible fracture on X-rays. |
Scaphoid Fracture | Pain in the anatomical snuffbox, with a risk of avascular necrosis if not properly treated. |
Carpal Bone Dislocation | Joint displacement visible on X-rays, with evident deformity. |
Wrist Contusion | Pain and swelling without visible fracture or avulsion on imaging. |
Emergency Management
Immediate immobilisation of the wrist with a splint or cast to prevent displacement of the bone fragment.
Application of ice to reduce swelling.
Administration of analgesics or anti-inflammatory drugs to control pain.
Request X-rays to confirm the fracture and assess the displacement of the fragment.
Referral for advanced imaging such as CT scans if the fracture is not evident but clinical suspicion of avulsion injury remains high.
Definitive Treatment
Treatment varies depending on the affected bone and the degree of displacement:
Non-displaced fractures: Conservative management with immobilisation using a cast or splint for 4-6 weeks.
Displaced fractures or those compromising joint stability: May require surgical fixation to reattach the bone fragment and restore the anatomy of the carpus.
After immobilisation or surgery, rehabilitation is essential to restore wrist mobility and strength.
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