Introduction
Anatomy
Symptoms
Diagnosis
Treatment
Rehabilitation
Outcome
Fracture of the distal end of the radius is the most common injury around the wrist. It is also the most common fracture seen in the upper limb. There is a bimodal distribution of such fracture, with the first peak in young individuals sustaining high-energy injuries like road traffic accidents or falling from height. The second peak is in elderly osteoporotic patients with low-energy injuries like level ground fall.
There are two bones in the forearm, namely radius and ulna. The wrist is a structure connecting the forearm and the hand. Injuries around the wrist can adversely affect the proper functioning of the hand.
There will be pain, swelling and deformity over the wrist area. Movement of fingers can be limited. If the energy of trauma is high, swelling can be severe, with associated numbness of fingers. In open fracture, bony fragments may pierce through the skin.
Diagnosis is mainly by x-ray of the injured wrist. Sometimes supplementary CT scan or MRI is needed to better delineate the fracture pattern or to look for associated soft tissue injuries, which can affect the way the fracture is treated.
To determine the best treatment for each patient, the following factors need to be considered:
The primary goal of treatment is to put (reduce) the fracture fragments back into appropriate alignment and let them heal in that position. Ways of achieving that include:
Rehabilitation for such injuries should start immediately afterwards. Finger swelling control and mobilisation is important, otherwise stiffness can develop, which can adversely affect hand function. Similarly, elbow and shoulder mobilisation should start early.
The fracture will typically unite in around 2 months. Splints, casts or external fixator can usually be removed in around 6 weeks after the injury. Internal fixation devices like plates and screws usually do not require removal. Several months is usually needed for maximal recovery from such injury.
The Hong Kong Society for Surgery of the Hand