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.
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  . 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  .
- 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 . Pain and reduced grip strength are infrequently reported .
- Lunate fracture - Similarly to scaphoid and distal radius fractures, injury to the lunate bone occurs after falling onto an outstretched hand , but compression injury or a direct blow to the wrist may be responsible as well  . It is very rarely encountered in practice, and wrist pain may be the only clinical sign .
- 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 . 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) , 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  .
- Trapezium - Direct high-level impact to the bone is the main mode of fracture, and is frequently associated with distal radial injury .
- Wrist Arthritis
There are many types of procedures that can be performed for wrist arthritis. [orthoinfo.aaos.org]
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]
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]
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 . 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 . 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 , 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  . 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) , which is why they are often recommended in early workup  . In some patients, technetium 99 (99 Te) bone scintigraphy may be used as a diagnostic tool .
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]
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]
At one extreme a stable, undisplaced extra-articular fracture has an excellent prognosis. At the other an unstable, displaced intra-articular fracture is difficult to treat and has a poor prognosis. [radiologyassistant.nl]
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]
Rehabilitation The prognosis for simple distal radius fractures is generally excellent. [midwestbonejoint.com]
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 of Wrist Joint Fractures- Several epidemiological studies performed in USA suggest that- Upper extremity injuries are the most common injuries seen in emergency room. [epainassist.com]
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]
Several studies support the efficacy of vitamin C in preventing CRPS-I, although the data are somewhat conflicting. [ncbi.nlm.nih.gov]
Injury Prevention Protective wrist splints may help prevent certain types of wrist injuries in specific sports. However, most wrist fractures are the result of accidental falls, and are difficult to prevent. [sportsmedtoday.com]
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