Emergency Medicine

288 Orthopaedic Emergencies

Injuries to the Wrist and Hand

DIAGNOSIS

1 Injury is caused by direct trauma or by falling onto an outstretched hand,

usua lly wit h an element of rotation fracturing bot h bones.

2 There is localized tenderness, swelling and deformity. Compound injuries

are more common with direct trauma.

(i) Monitor for neurovascular compromise, compartment syndrome

and musculotendinous injury.

3 X-ray will demonstrate the fractures. Look closely for an associated dis-

location injury if one bone is fractured and angulated, but with no

radiographic evidence of the other bone being broken.

(i) Monteggia fracture: fracture of the proximal ulna with

dislocation of the radial head. Dislocation is present if a line

through the radius fails to bisect the capitellum in both X-ray

views.

(ii) Galeazzi fracture: fracture of the distal radius with dislocation

of the inferior radio-ulnar joint at the wrist. Look for widening

at the distal radio-ulnar joint space and dorsal displacement of

the ulnar head on X-rays. An associated ulnar styloid fracture is

common.

MANAGEMENT

1 Refer all these fractures to the orthopaedic team for open reduction and

internal fixation.

2 Place the arm in a full-arm plaster cast from the metacarpal heads to the

upper arm, with the elbow f lexed at a right angle and the wrist in the

mid-position, in the rare instance of an isolated, undisplaced, single forearm

bone fracture.

(i) Refer the patient to the next fracture clinic.

INJURIES TO THE WRIST AND HAND

Colles’ fracture

DIAGNOSIS

1 This is a fracture of the distal radius usually within 2.5 cm of the wrist. It is

most common in elderly women with osteoporosis and usually associated

with a fall onto the outstretched hand.

2 The classical ‘dinner fork’ deformity is due to dorsal angulation and dorsal

displacement of the distal radial fragment, which may also be impacted and

radially displaced.