Wrist Fractures

Colles fractures (fracture of the distal radius) are the most common fracture in adults and are typically caused by a fall on an outstretched hand. The two categories that are most predominant are osteopenic females aged between 60-80 and males between 20-40. The former is typically a low-energy injury at a ratio of male:female 1:4. The latter is typically a high-energy fall to impact on the denser bone.

The angle of the wrist on impact (primarily ulnar/radial deviation and dorsiflexion) and the weight of the patient ultimately determine the fracture pattern, whether of the radius, scaphoid and the ulna.

Signs & Symptoms:

• History of trauma or osteoporosis
• Wrist pain
• Tenderness over the fracture sight (distal radius/ulna or carpals)
• Swelling
• Deformity (for displaced fractures)
• Tenderness in the anatomic snuff box (suggestive of a scaphoid fracture)
• Finger numbness (high-energy injuries typically on the median nerve)

Other pathologies with similar signs and symptoms include:

• Wrist strains (no deformity or signs on x-ray)
• Ligamentous carpal injury (pain with palpation on dorsum of wrist at the scapholunate interval)
• Triangular fibrocartliage complex tear (ulnar sided wrist pain increasing on ulnar deviation)

The need for surgical intervention is determined from radiography. Surgery is indicated when there is radial length loss of 15mm or more or when there is a dorsal tilt of over 10 degrees.

Initial treatment is typically immobilisation by cast or splint. For undisplaced fractures, cast are normally maintained for 4-6 weeks. Undisplaced fractures may also result in spontaneous rupture of the extensor pollicis longus tendon; typically in the first 12-16 weeks after injury. Precisely why I don't know, however spontaneous EPL rupture also occurs in synovitis, tenosynovitis and RA. There's even the occasional case where the patient doesn't have any predisposing factors, but has a spontaneous EPL rupture none the less.

Interestingly, a HEP and application of ultrasound and ice has is supported by limited evidence (AAOS Treatment Guidelines), however patients perform active finger motion exercises following diagnosis. Furthermore there is moderate evidence to support that patients do not begin early wrist motion following stable fracture fixation. The prescription of Vitamin C also has moderate evidence to prevent disproportionate pain.