Emergency Medicine

292 Orthopaedic Emergencies

INJURIES TO THE WRIST AND HAND

MANAGEMENT

1 Apply a Colles’-type plaster backslab.

2 Give the patient a sling, with instructions to keep the shoulder and fingers

moving, and review in the next fracture clinic.

(i) Operative fixation may be necessary, and physiotherapy is

required particularly if Sudeck’s atrophy occurs.

Distal radial fractures in children

DIAGNOSIS

1 These represent the most common paediatric fractures.

2 They are associated with marked local tenderness, sometimes with

deformity.

3 Request an X-ray to show the nature of the fracture:

(i) Plastic deformation: most commonly associated with the ulna.

(ii) Greenstick fracture: occurs when one side of a bone breaks as the

opposite side is bent, usually where the force was directly applied.

(iii) Buckle or ‘torus’ fracture: compressive forces cause one side of

the bone to ‘buckle’ under pressure as the opposite side is bent.

(iv) Complete fracture: involves the entire bone and both cortical

surfaces.

(v) Epiphyseal fracture: involves the growth plate and is classified

using the Salter–Harris system. The radial epiphysis may displace

dorsally, often in adolescents, to mimic a Colles’ deformity.

MANAGEMENT

1 Refer all angulated fractures and displaced radial epiphyses to the ortho-

paedic team for reduction under general anaesthesia.

2 Otherwise, place the forearm in a Colles’-type plaster backslab for a

minimally buckled cortex, which may be difficult to even see on an X-ray.

Refer the patient to the next fracture clinic.

Fractures of the scaphoid

DIAGNOSIS

1 The scaphoid is the most commonly fractured carpal bone, usually caused

by a fall onto the outstretched hand. Consider this in any patient presenting

with a ‘sprained wrist’, particularly after a sporting injury.

2 There is pain on dorsif lexion or ulnar deviation of the wrist, as well as pain

and weakness of pinch grip.