Wrist Fractures

Question 1

Fractures of the distal … are common orthopaedic injuries.

Answer 1

Fractures of the distal radius are common orthopaedic injuries.

Question 2

Wrist fracture is a term that can refer to any fracture affecting the distal radius, ulna or carpal bones. However, generally, it is used interchangeably to describe a fracture of the distal … and any accompanied … fracture.

Answer 2

Wrist fracture is a term that can refer to any fracture affecting the distal radius, ulna or carpal bones. However, generally, it is used interchangeably to describe a fracture of the distal radius and any accompanied ulna fracture.

Question 3

Fractures of the distal radius exhibit a … distribution; they are seen in the young following high-energy injuries and as fragility fractures in the elderly.

Answer 3

Fractures of the distal radius exhibit a bimodal distribution; they are seen in the young following high-energy injuries and as fragility fractures in the elderly.

Question 4

The wrist is a synovial joint formed by the distal radius, … disc and proximal … bones.

Answer 4

The wrist is a synovial joint formed by the distal radius, articular disc and proximal carpal bones.

Question 5

The radiocarpal (wrist) joint is a … joint formed by the distal articular surface of the radius and the articular disc with the scaphoid, lunate and triquetrum. It is a biaxial and ellipsoid joint. The … does not form part of the radiocarpal joint.

Answer 5

The radiocarpal (wrist) joint is a synovial joint formed by the distal articular surface of the radius and the articular disc with the scaphoid, lunate and triquetrum. It is a biaxial and ellipsoid joint. The ulna does not form part of the radiocarpal joint.

Question 6

Whilst held in a neutral position only the scaphoid and lunate are in contact with the radius and articular disc. When the wrist is held in adduction the … comes into contact with the articular disc.

Answer 6

Whilst held in a neutral position only the scaphoid and lunate are in contact with the radius and articular disc. When the wrist is held in adduction the triquetrum comes into contact with the articular disc.

Question 7

Colles’ fracture - what is this?

Answer 7

A type of distal radius fracture defined as an extra-articular fracture of the metaphyseal region of the radius with dorsal angulation (of the distal fragment) and impaction. It is classically caused by a ‘fall onto outstretched hand’ (or FOOSH - an acronym you will often see in orthopaedic clerkings). There is an associated fracture of the ulna styloid in around 50% of cases.

Question 8

Smith’s fracture - what is this?

Answer 8

Often described as a reverse Colles’. Refers to a fracture of the distal radius with volar angulation of the distal fragment. Tend to be inherently less stable than fractures with dorsal angulation.

Smith’s fractures tend to result from a fall onto a flexed hand or a direct blow to the back of the wrist.

Question 9

Barton fracture - what is this?

Answer 9

Barton fracture describes an intra-articular fracture of the distal radius. Intra-articular involvement increases the risk of arthritis and reduced function. They may have dorsal angulation or volar angulation (volar Barton).

Question 10

… … fractures most commonly result from a fall onto an outstretched hand (FOOSH).

Answer 10

Distal radius fractures most commonly result from a fall onto an outstretched hand (FOOSH).

Question 11

Distal radius fractures most commonly result from a fall onto an … hand (FOOSH).

Answer 11

Distal radius fractures most commonly result from a fall onto an outstretched hand (FOOSH).

Question 12

Symptoms and signs of wrist fractures

Answer 12

Pain
Reduced range of movement

Boney tenderness
Swelling
Deformity

Question 13

The diagnosis of a wrist fracture may be made clinically and confirmed by a wrist …

Answer 13

The diagnosis of a wrist fracture may be made clinically and confirmed by a wrist radiograph.

Question 14

What are these films referred to as?

Answer 14

Question 15

Initial management of wrist fractures

Answer 15

The majority patients presenting with fractures of the distal radius receive their initial management in ED. For those with extra-articular fractures most will attempt a closed reduction and cast immobilisation with appropriate analgesia (e.g. haematoma block and gas & air).

Question 16

Dorsal angulation - under 65 years

Answer 16

The fracture, patient wishes and co-morbidities will be considered. Review should include examination of the ulnar variance, dorsal tilt and intra-articular step (if present).

Surgery will typically be considered. If closed reduction is possible then K-wire fixation if generally preferred to ORIF (open reduction and internal fixation).

Question 17

Dorsal angulation - over 65 years

Answer 17

In more elderly patients non-operative management will be likely considered as definitive management. Where there is instability, significant deformity or neurological compromise surgery will be considered.

Question 18

Volar angulated fractures are inherently ….

Answer 18

Volar angulated fractures are inherently unstable.

Volar angulated fractures are inherently unstable. As a general rule these are managed with open reduction and plate fixation. Once again radiographical findings, patient co-morbidities and wishes must be taken into account.

Question 19

… angulated fractures are inherently unstable. As a general rule these are managed with open reduction and plate fixation. Once again radiographical findings, patient co-morbidities and wishes must be taken into account.

Answer 19

Volar angulated fractures are inherently unstable. As a general rule these are managed with open reduction and plate fixation. Once again radiographical findings, patient co-morbidities and wishes must be taken into account.

Question 20

Open fractures should be managed as per the … open fracture guideline.

Answer 20

Open fractures should be managed as per the BOAST open fracture guideline.

Question 21

Early complications of distal radius fracture (4)

Answer 21

Median nerve neuropathy
Ulnar nerve neuropathy
Extensor pollicis longus or flexor pollicis longus rupture
Compartment syndrome

Question 22

Medium to late complications of distal radius fracture (5)

Answer 22

Osteoarthritis
Non-union / mal-union
Complex regional pain syndrome
Metalwork infection
Metalwork irritation