FRACTURES OF THE WRIST AND HAND

Dr. Saad Abdul Aziz

Colle’s fracture

is a transverse fracture of the distal radius just above the wrist with dorsal displacement of the distal fragment.

It’s the most common of all fractures in older people.

Mechanism of injury fall on outstretched hand, its either

undisplaced or displaced . In displaced fracture the distal fragment

collapses into extension, dorsal displacement, radial tilt and shortening.

Clinical features :pain, tenderness, and deformity.

X-rays: AP&Lat. Views

Treatment :Undisplaced fracture Displaced fracture: :

Comminuted colles fracture:   Complications: Early: 1-circulation of the fingers. Median nerve compression. Reflex sympathetic dystrophy: swelling and tenderness of the fingers joints,

stiffness, signs of vasomotor instability. X-rays shows osteoporosis. Ligamental injury.   Late : Malunion. Delay union. Non union Stiffness of the shoulder, elbow, wrist and fingers. Osteo arthritis.  

Smith fracture: Treatment:

Distal forearm fracture in children (juvenile colles:)

The fracture may occur through the distal radial physis or in the metaphysic of one or both bones. Metaphyseal fravtures are often incomplete or green-stick.Mechanism of injury:

Clinical features:

X-rays:

Treatment:

Complications: + Radio-ulnar discrepancy.

Radial styloid fracture

Caused by forced radial deviation of the wrist.the fracture line is extend laterally from the articular surface of the radius.

Treatment:

Fracture- sublaxation of the radiocarpal joint: (Barton's fracture)

Volar or dorsal sublaxation,   Treatment : undisplaced fracture: casting

below elbow for 6wks. Displaced fracture: open

reduction and internal fixation.  

Complications of radiocarpal fractures: Early: 1-associated injuries of the carpus. 2- redisplacement. Late: 1- carpal instability. 2-secondary osteoarthritis. 

Carpal injuries

Scaphoid fractures: Its account for almost 75% of all carpal

fractures, its rare in the elderly and children.

  Mechanism of fracture: fall on dorsiflexed

hand. Stable and unstable fractures.

Clinical features:

X-ray : AP, Lateral and oblique views .

Treatment: Undisplaced fracture : casting on glass-

holding position for 6 wks. Displaced fracture: open reduction and

internal fixation.

Surgical treatment

  Complications: Avascular necrosis: the proximal

fragment may die, especially with proximal pole fracture. It appears dense on X-ray after 2-3 months.

Non-union: if the fracture is not united after 3 months.

Osteoarthritis 

Metacarpal fractures:

Fracture of metacarpal shaft: transverse or spiral

Fracture of the metacarpal neck: usually of the 5th finger (boxer's fracture), localized swelling with flattening of the knuckle.

Fracture of the metacarpal base.

 

  Fractures of the thumb metacarpal

Bennett's fracture: it’s the fracture and dislocation of the base of the 1st metacarpal