Edit concept Question Editor Create issue ticket

Wrist Fracture

The distal radius, scaphoid, lunate, triquetrum, trapezium and hook of hamate have all been recognized as possible sites of fracture in the wrist, and their clinical presentation may somewhat vary. The diagnosis rests on the use of imaging studies guided by information obtained from patient history and physical examination.


Presentation

Most important wrist fracture types and their respective clinical presentations are:

  • Distal radius fractures - Being the most common type of wrist fracture, distal radius fracture encompasses 17% of all fractures seen in the emergency department, and falling onto an outstretched hand (often encountered in ice hockey players and both ice and inline skaters) is the main mechanism of injury [1] [2]. Swelling of the wrist, a limited range of motion, tenderness along the distal radius and injury of the median nerve leading to numbness of the tip of the index finger can be observed during physical examination [2] [3].
  • Scaphoid fracture - Seen in previously healthy and young individuals who either fall on the outstretched arm or provoke a forced dorsiflexion of the wrist, this type of fracture presents with tenderness over the anatomic snuff box or the distal scaphoid tubercle, accompanied by a limited range of motion [4]. Pain and reduced grip strength are infrequently reported [4].
  • Lunate fracture - Similarly to scaphoid and distal radius fractures, injury to the lunate bone occurs after falling onto an outstretched hand [1], but compression injury or a direct blow to the wrist may be responsible as well [1] [5]. It is very rarely encountered in practice, and wrist pain may be the only clinical sign [5].
  • The hook of hamate fracture - Baseball, golf, and tennis players are shown to be at the highest risk for this type of fracture since transmission of the force from the bat, club or racquet to the palm is the mechanism of fracture [2]. Ulnar or median nerve injury manifesting as numbness, as well as wrist pain, are main complaints.
  • Triquetrum fracture - Dorsal cortical fracture of the triquetrum is regarded as the second most common carpal fracture (after scaphoid) [2], and symptoms include nonspecific tenderness and swelling. The diagnosis is frequently misinterpreted as wrist sprain, however, which is why detailed radiographic workups are imperative in distinguishing between different types of injury [1] [2].
  • Trapezium - Direct high-level impact to the bone is the main mode of fracture, and is frequently associated with distal radial injury [2].
Wrist Arthritis
  • Wrist arthritis may occur following a distal radius fracture. This can be the result of cartilage injury at the time of the break, or wear and tear from changes in the joint alignment after the bone is healed.[eatonhand.com]
  • There are many types of procedures that can be performed for wrist arthritis.[orthoinfo.aaos.org]
  • Thumb & Wrist Injuries Bennett's Fracture (Scaphoid) Broken Wrist (Colles) Broken Wrist (Capitate) Broken Wrist Broken Wrist Carpal Tunnel Syndrome Mallet Finger Sprained Thumb Wrist Arthritis[physioroom.com]
  • Patient age, activity level, hobbies, occupation, hand dominance, prior injuries or wrist arthritis, and other medical problems are very important when considering treatment.[ucdenver.edu]
Short Arm
  • The patient is then placed in a short arm cast until the fracture is healed.[uwhealth.org]
  • arm cast) and the use of the StabilAir brace for each patient qualified by specific criteria.[clinicaltrials.gov]
  • After the swelling has subsided, a short arm cast, long arm cast or fracture brace is usually recommended.[midwestbonejoint.com]
Osteopenia
  • BACKGROUND: Fractures lead to reduced physical function and quality of life (QOL), but little is known about postmenopausal women with osteopenia and a healed wrist fracture.[ncbi.nlm.nih.gov]
  • However, few studies have evaluated the effect of such programmes for women with low bone mineral density (BMD) (osteoporosis or osteopenia) who have already suffered a fracture.[ncbi.nlm.nih.gov]
  • Bone densitometry completed on 55 patients in the first year indicated OP or osteopenia in 43 of 55 patients. Patients' health beliefs underestimated the seriousness of OP.[ncbi.nlm.nih.gov]
Recurrent Fractures
  • One patient died, and 4 others experienced recurrent fracture. INTERPRETATION: A multifaceted intervention directed at high-risk patients and their physicians substantially increased rates of testing and treatment for osteoporosis.[ncbi.nlm.nih.gov]
Suggestibility
  • CONCLUSIONS: Persistent postsurgical pain 1 yr after wrist and ankle fracture surgery is frequent, and a large proportion of patients experience symptoms suggestive of neuropathic pain and CRPS.[ncbi.nlm.nih.gov]
  • BACKGROUND: Evidence suggesting that a diet high in fruits and vegetables may be beneficial to bone health has sparked interest in the potential benefit of a vegetarian diet.[ncbi.nlm.nih.gov]
  • In 1997, the hip fracture rate began to decrease, and the population projections suggest that this downward trend will continue to a rate of 33.1 per 10,000 in 2005.[ncbi.nlm.nih.gov]
  • As suggested by the physical theory of ultrasound attenuation, our results support the idea that BUA reflects not only the bone density but also other factors related to the structural properties of bone.[ncbi.nlm.nih.gov]
  • DISCUSSION: Women and older individuals experienced the greatest reductions in HRQoL and functionality after a fall-related wrist facture, suggesting that they might merit special attention in clinical care and public health policy.[ncbi.nlm.nih.gov]

Workup

Patient history and findings observed during the physical examination are sufficient in turning the physician's attention to a wrist-related pathology, but imaging studies are necessary to confirm the presence of a fracture. Plain radiography of the injured wrist is an excellent initial method, but only if images are obtained in the adequate plane, depending on the site of injury [1]. For example, scaphoid fractures require a lateral radiographic view, while distal radius fractures require both posteroanterior (PA) and lateral views, an external oblique projection and a PA image with ulnar deviation of the wrist [1]. If the cause of symptoms is undisclosed with plain radiography, more sensitive imaging methods should be employed. Ultrasonography is recommended in the setting of suspected scaphoid fractures [6], but it is regarded as an inferior procedure compared to computed tomography (CT) and magnetic resonance imaging (MRI), described as the gold standard in imaging workup of the wrist [2] [7]. These procedures can determine the exact site of fracture with great efficacy, and more importantly, determine the presence of other potential injuries (e.g., soft tissue injuries such as ligament tears or additional fractures) [2], which is why they are often recommended in early workup [2] [7]. In some patients, technetium 99 (99 Te) bone scintigraphy may be used as a diagnostic tool [1].

Treatment

  • Participants were divided into two treatment groups: computer-aided treatment (high technology) and traditional brush machine treatment (low technology).[ncbi.nlm.nih.gov]
  • BACKGROUND: Despite the high risk for future fractures and the availability of effective treatments, fewer than 10% to 20% of patients who sustain a fragility fracture are tested or treated for osteoporosis.[ncbi.nlm.nih.gov]
  • Primary outcome was bisphosphonate treatment and secondary outcomes were BMD testing, appropriate care (BMD test-treatment if bone mass low), and costs.[ncbi.nlm.nih.gov]
  • Patients who believe that weak bones didn't cause their fracture require additional attention to motivate them to undergo special treatment.[ncbi.nlm.nih.gov]
  • The primary outcome was bisphosphonate treatment within 6 months after the fracture.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis Rate of recovery and the prognosis from a wrist fracture will depend on a number of factors: Severity – Minor fractures do well with immobilization and hand therapy, while fractures that are more severe and require surgery or effect joint integrity[twinboro.com]
  • Wrist Injury Prognosis (Outlook) Most wrist sprains should be better in three to five days. If you have symptoms that last beyond five days, you should see your doctor for reevaluation. The outcome of a fracture depends on the type of fracture.[emedicinehealth.com]
  • Existing evidence suggests an association between fracture type and received treatment with further functional prognosis [ 4 – 8 ].[bmcgeriatr.biomedcentral.com]
  • Rehabilitation The prognosis for simple distal radius fractures is generally excellent.[midwestbonejoint.com]

Etiology

  • Although a shared genetic etiology is often assumed between fracture and low BMD, this has not been shown to be the case.[ncbi.nlm.nih.gov]
  • Background & Etiology The wrist joint is comprised of the distal ends of the radius and ulna (forearm bones) and eight carpal bones (which form the “floor” of the carpal tunnel.) A fracture is defined as a partial or complete crack in a bone.[twinboro.com]

Epidemiology

  • Epidemiology Fractures of the wrist are common, representing about a quarter of all fractures of limbs. They are more common in children and in young adults, especially those involved in risk-taking activities.[patient.info]
  • Fractures in Children: Epidemiology and Activity – Specific Fracture Rates. J Bone Joint Surg Am, 2013 Apr 03;95(7). CONTINUE SCROLLING FOR RELATED SLIDESHOW[medicinenet.com]
Sex distribution
Age distribution

Prevention

  • Several studies support the efficacy of vitamin C in preventing CRPS-I, although the data are somewhat conflicting.[ncbi.nlm.nih.gov]
  • Resources and preventative measures should be targeted towards these high risk patients to prevent the catastrophic event of a hip fracture.[ncbi.nlm.nih.gov]
  • Estimated adjusted second fracture probabilities may facilitate population-based evaluation of secondary fracture prevention strategies.[ncbi.nlm.nih.gov]
  • So, wrist fracture female patients must be appropriately screened and treated for osteoporosis in order to preserve bone quality and prevent future, more severe, fractures.[ncbi.nlm.nih.gov]
  • Early recognition and treatment of any of these factors can prevent long-term problems. But is it possible to tell ahead of time who might develop acute CTS after distal radial fracture? The goal would be to prevent carpal tunnel syndrome.[eorthopod.com]

References

Article

  1. Goldfarb CA, Yin Y, Gilula LA, Fisher AJ, Boyer MI. Wrist fractures: what the clinician wants to know. Radiology. 2001;219(1):11-28.
  2. Chen NC, Jupiter JB, Jebson PJL. Sports-Related Wrist Injuries in Adults. Sports Health. 2009;1(6):469-477.
  3. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  4. Steinmann SP, Adams JE. Scaphoid fractures and nonunions: diagnosis and treatment. J Orthop Sci. 2006;11(4):424-431.
  5. Galbraith PJ, Richardson ML. Fracture of the Lunate: Radiographic Findings and Case Report. Radiol Case Rep. 2007;2(1):13-16.
  6. Senall JA, Failla JM, Bouffard JA, van Holsbeeck M. Ultrasound for the early diagnosis of clinically suspected scaphoid fracture. J Hand Surg Am. 2004;29(3):400-405.
  7. Murthy NS, Ringler MD. MR Imaging of Carpal Fractures. Magn Reson Imaging Clin N Am. 2015;23(3):405-416.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-22 10:48