Bone Injuries of the Hand and Wrist

MANUAL MINORS

Bone injuries of the hand and wrist are common due to the large number of small bones and joints in these areas, making them susceptible to fractures and trauma from direct impact or falls. The most commonly affected bones include the scaphoid, distal radius, and phalanges. These injuries can cause pain, swelling, limited movement, and, if not properly treated, can lead to complications such as malunion or avascular necrosis, especially in bones like the scaphoid.

Diagnosis

Diagnosis is based on the clinical history of trauma, followed by a physical examination to detect localized pain, swelling, deformities, and limited range of motion. X-rays are essential to evaluate fractures, dislocations, or fissures in the bones of the hand and wrist. In cases where fractures are not visible on conventional X-rays, especially in the scaphoid, magnetic resonance imaging (MRI) or computed tomography (CT) may be necessary to confirm the diagnosis.

Differential Diagnosis

Injury	Distinctive Features
Scaphoid fracture	Pain in the anatomical snuffbox after a fall on an outstretched hand, high risk of avascular necrosis.
Colles’ fracture	Distal radius fracture, “dinner fork” deformity after a fall on an outstretched hand.
Smith’s fracture	Distal radius fracture with volar displacement after a fall on a flexed hand.
Phalangeal fractures	Intense pain, visible deformity or angulation of the fingers, usually from direct trauma.
Carpal joint dislocation	Displacement of carpal bones, severe pain and wrist deformity, common in lunate dislocations.

Emergency Management

The management of hand and wrist fractures in emergencies depends on the stability of the fracture and the patient’s pain level. In most cases, the affected joint is immobilised with a splint or cast, and analgesia is provided using nonsteroidal anti-inflammatory drugs (NSAIDs) or, in severe cases, opioids.

Displaced fractures may require closed reduction before immobilisation. If a scaphoid fracture is suspected, even if not visible on the initial X-ray, the joint should be immobilised and re-evaluated with additional imaging.

Definitive Treatment

Definitive treatment varies depending on the type of fracture. Non-displaced fractures can be treated with a cast for 4 to 6 weeks, followed by physical therapy to restore mobility. Displaced, unstable, or comminuted fractures often require surgical intervention, such as internal fixation with screws or plates. For scaphoid fractures, strict follow-up is essential due to the risk of avascular necrosis.