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P R E S E N T E D B Y:
J E S S I C A AYO U B

Wrist anatomy

Wrist bones

Definition
extra-articular

transverse distal
radius fracture (~2 cm proximal to
the radiocarpal joint)
dorsal displacement ulnar styloid
fracture(50%)
Impaction with resultant shortening
of the radius
>40 yr, osteoporotic females
FOOSH: fall on an outstretched hand

Originally named by Abraham

Colles (1773-1843), Irish surgeon,
Dublin.

Mechanism

FOOSH with a pronated

forearm in dorsiflexion (the
position one adopts when
trying to break a forward
fall).

proximal row of the carpus,

mostly the lunate and
scaphoid, transfer energy to
the distal radius (both in the
dorsal direction and along
the long axis of the radius)
dorsally angulated and
impacted fracture.

Colles fracture: radiographic

features

Diagnosis: x-ray: AP and

lateral wrist

dinner fork deformity

Clinical features:
swelling,
ecchymoses,
tenderness

Plain film

Frykman classification system

TREATMENT
Closed reduction and cast immobilisation
for 5-6 wk
cast extends from below the elbow to the
metacarpal heads and holds the wrist somewhat
flexed and in ulnar deviation
x-ray x 1 wk for 3 wk and at cessation of
immobilization to ensure reduction is maintained

Colles cast

TREATMENT
ORIF Colles' Fracture if PostReduction Demonstrates:
Radial shortening >3 mm or,
Dorsal tilt >10 or,
Intra-articular
displacement/step-off >2 mm

Colles versus Smith fracture

volar

displacement of the distal radius:

reverse Colles fracture
a fall onto a flexed wrist
Direct blow to the back of the wrist
3%

fractures of the radius and ulna

bimodal distribution: young males (most
common) and elderly females

Smith fracture

type

I:extra-articular
transverse fracture through
the distal radius; most
common: ~85%
type II: intra-articular
oblique fracture :~13%
type III: juxta-articular
oblique fracture:
uncommon: <2%

Radiographic features

TYPE I

FRONTAL

LATERAL

TYPE II
In intra-articular fractures (type II) the degree of articular stepoff and gap should be assessed, and this may require CT.

TREATMENT

unstable and needs ORIF

if poor operative candidate, attempt non-operative
treatment
closed reduction with hematoma block (reduction opposite
of Colles)
long-arm cast in supination x 6 w

Early and Late Complications of Wrist Fractures

Early

Difficult

reduction loss
of reduction
Compartment syndrome
Extensor pollicis longus
tendon rupture
Acute carpal tunnel
syndrome
Finger swelling with
venous block
Complications of a tight
cast/splint

Late

Malunion,

radial
shortening
Painful wrist secondary
to ulnar prominence
Frozen shoulder
(shoulder-hand
syndrome)
Post-traumatic arthritis
Carpal tunnel syndrome
CRPS/RSD

Crps: complex regional pain syndrome

Rsd : reflex sympathetic dystrophy

Scaphoid fracture

SCAPHOID FRACTURE
common

in young

men;
not common in
children or in patients
beyond middle age

most common
carpal bone injured

FOOSH: impaction of
scaphoid on distal radius,
most commonly resulting in a
transverse
fracture through the waist
(65%), distal (10%), or
proximal (25%) scaphoid

Clinical Features
pain with wrist movement
tenderness in the anatomical snuff
box, over scaphoid tubercle, and pain
with long axis compression into scaphoid
usually nondisplaced

INVESTIGATIONS
x-ray: PA, lateral, scaphoid views with wrist extension and
ulnar deviation x 2 wk
CT or MRI
bone scan rarely used

Note

: a fracture may not be radiologically

evident up to 2 wk after acute injury,
-if wrist pain &anatomical snuff box tenderness but a
negative x-ray
treat as if positive for a scaphoid
fracture and repeat x-ray 2 wk later to rule out a fracture;
if x-ray still negative order CT or MRI

(Left) This x-ray shows a scaphoid fracture fixed in place with a screw.
(Right) This x-ray was taken 4 months after surgery. The fracture of the
scaphoid is healed

TREATMENT
non-displaced (<1 mm
displacement/<15 angulation): long-arm
thumb spica cast x 4 wk then short arm
cast until radiographic evidence of
healing is seen (2-3 mo)
displaced: ORIF with
headless/countersink compression screw
is the mainstay treatment, or
percutaneous K-wire fixation (uncommon )

Kirschner wires or K-wires or pins are sterilized,

sharpened, smooth stainless steel pins.

THUMB SPICA CAST

most

common: non-union/mal-union
(use bone graft from iliac crest or distal
radius with fixation to heal)
AVN of the proximal fragment
delayed union (recommend surgical
fixation).

Specific Complications

PROGNOSIS
fractures of the proximal third
of the scaphoid have 70% rate of
non-union or AVN
waist fractures have healing
rates of 80-90%
distal third fractures have
healing rates close to 100%

RECOVERY

Avoid heavy lifting, carrying, pushing,

pulling, or throwing with the injured
arm
Do not participate in contact sports
Do not climb ladders or trees
Avoid activities with a risk of falling
onto hand (for example, inline
skating, jumping on a trampoline)

Rehabilitation exercises

References
http://orthoinfo.aaos.org/
Toronto

notes 2015
http://radiopaedia.org/

K
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T OU
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 A hematoma block is an analgesic technique

used to allow painless manipulation of
fractures while avoiding the need for full
anesthesia. This procedure is normally only
appropriate for fractures of the radius and/or
ulna, and occasionally for fractures of the
lower ends of the tibia and fibula
hematoma block (sterile prep and drape,
local anesthetic injection directly into
fracture site)or conscious sedation.

 Complex regional pain syndrome (CRPS) formerly reflex sympathetic dystrophy (RSD), "causalgia", or reflex
neurovascular dystrophy (RND) is an amplified musculoskeletal pain syndrome (AMPS). It is a chronic systemic
disease characterized by severe pain, swelling, and changes in the skin. CRPS often worsens over time. It may
initially affect an arm or leg and spread throughout the body; 35% of people report symptoms throughout their
whole body.[1] Other potential effects include: systemic autonomic dysregulation; neurogenic edema;
musculoskeletal, endocrine, or dermatological manifestations; and changes in urological or gastrointestinal
function.
CRPS is associated with dysregulation of the central nervous system[3] and autonomic nervous system resulting
in multiple functional loss, impairment, and disability
The exact cause of RSDS is not fully understood, although it may be associated with injury to the nerves, trauma,
surgery, atherosclerotic cardiovascular disease, infection, or radiation therapy
-Frozen shoulder, also called adhesive capsulitis, causes pain and stiffness in the shoulder. Over time, the
shoulder becomes very hard to move.
Frozen shoulder occurs in about 2% of the general population. It most commonly affects people between the ages
of 40 and 60, and occurs in women more often than men.
Diabetes. Frozen shoulder occurs much more often in people with diabetes, affecting 10% to 20% of these
individuals. The reason for this is not known.
Other diseases. Some additional medical problems associated with frozen shoulder include hypothyroidism,
hyperthyroidism, Parkinson's disease, and cardiac disease.
Immobilization. Frozen shoulder can develop after a shoulder has been immobilized for a period of time due to
surgery, a fracture, or other injury. Having patients move their shoulders soon after injury or surgery is one
measure prescribed to prevent frozen shoulder.