Principles of Fracture Management - Wrist Fractures

Question 1

What is a Colle’s Fracture?

Answer 1

Transverse fracture of the distal radius 1 inch proximal to the radio-carpal joint near the wrist.

Question 2

Aetiology of Colle’s Fracture.

Answer 2

FOOSH - Fall onto Outstretched hand.

Question 3

Clinical Presentation of Colle’s Fracture.

Answer 3

Dinner Fork Deformity : Distal Portion Displaces Posteriorly (upside down fork and hand down).

Question 4

Complications of Colle’s Fractures (7).

Answer 4

1. Malunion/Non-union.
2. Sudek’s Atrophy / Complex Regional Pain Syndrome.
3. External Policis Longus Rupture.
4. Medial Nerve Injury (& Carpal Tunnel Syndrome).
5. Frozen Shoulder due to FOOSH.

Question 5

Aetiology of Scaphoid Fracture.

Answer 5

FOOSH.

Question 6

Clinical Presentation of Scaphoid Fracture.

Answer 6

1. Tenderness in Anatomical Snuffbox.
2. Loss of Grip/Pinch Strength.
3. Wrist Joint Effusion (after 4 hours and before 4 days).
4. Pain - Telescoping of Thumb (Longitudinal Compression).
5. Pain - Ulnar Deviation

Question 7

Complications of Scaphoid Fracture (3).

Answer 7

Vulnerable Blood Supply :

1. Avascular Necrosis (Retrograde Blood Supply).
2. Non-Union.
3. Impaired Healing.
   * scaphoid, femoral head, humeral head, talus, navicular, 5th metatarsal.

Question 8

Vascular Supply of Scaphoid.

Answer 8

Retrograde supply from dorsal carpal branch (radial artery).

Question 9

Management of Scaphoid Fracture.

Answer 9

1. Immobilise with Future Splint/Standard Below-Elbow Backslab.
2. Refer to Orthopaedics and clinical review 7-10 days later.
3. Cast for 6-8 weeks if undisplaced and surgical fixation if displaced or proximal scaphoid pole fracture.