MANUAL MINORS
Wrist fractures involve the carpal bones (especially the scaphoid) or the distal ends of the radius and ulna. These fractures commonly result from falls onto an outstretched hand or direct trauma. The distal radius fracture is the most frequent, with Colles’ fracture being notable for its dorsal displacement of the distal fragment.
Diagnosis
The diagnosis is based on a history of trauma, acute wrist pain, swelling, deformity (in some fractures like Colles’), and limited movement. X-rays are essential to confirm the type and location of the fracture. In suspected cases of carpal fractures (such as the scaphoid), additional studies like CT scans or MRI may be required.
Differential Diagnosis
Condition | Key Differences |
|---|---|
Wrist Sprain | Pain and swelling, but no fracture visible on X-ray. |
Wrist Dislocation | Joint displacement without visible bone fracture, often with significant deformity. |
Barton’s Fracture-Dislocation | Fracture of the distal radius rim with carpal dislocation, visible on X-ray. |
Scaphoid Fracture | Localised pain in the anatomical snuffbox, often difficult to detect on initial X-ray. |
Emergency Management
Immediate immobilisation of the wrist with a splint or cast in a functional position to prevent further damage.
Application of ice to reduce swelling and administration of analgesics or anti-inflammatories for pain control.
X-rays to confirm the fracture and determine its severity.
Closed reduction if there is significant displacement, followed by immobilisation with a cast or splint.
Definitive Treatment
The treatment depends on the type and severity of the fracture:
Non-displaced fractures: Managed with immobilisation in a cast for 4-6 weeks.
Displaced or unstable fractures: Require closed or open reduction, and sometimes internal fixation with plates or screws.
Scaphoid fractures: May need prolonged immobilisation (6-12 weeks) or surgery if there is a risk of non-union.
Physical rehabilitation is crucial to restore wrist mobility, strength, and function after immobilisation or surgery.
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