This document discusses various types of wrist fractures including scaphoid fractures, Colles' fractures, Smith's fractures, and Barton's fractures. Scaphoid fractures are the most common carpal bone fractures, often occurring in the waist or mid-portion from falls onto an outstretched hand. Physical examination findings and imaging can help diagnose these fractures. Treatment depends on fracture stability and displacement, ranging from splinting to screw fixation. Complications may include malunion or avascular necrosis.

1. Distal radial ulnar fracture/scaphoid #
Dr abdul rub
Attending consultant emergency department

2. Discussion
• ! Scaphoid fracture
• Colles fracture
• Smiths fracture
• Barton's fracture

3. Scaphoid Fractures
• 71% of all carpal bone fractures.
•aged 15-60 years.
•About 5-12% of scaphoid fractures are associated
with other fractures
•70-80% occur at the waist or mid-portion
•10-20% proximal pole

5. Physical examination

6. Physical examination
•Snuff box tenderness 100% sensitivity
•Scaphoid tubercle tenderness 20% specific
•Adding Scaphoid compression test :
Specificity reaches 74% (Parvizi et al)

7. Suggested by:
• patient’s age,
• mechanism of injury
• signs and symptoms
Imaging
• Xray….Can miss 20%of #
• CT Scan-for staging & if plain flims normal
• MRI-most sensitive test(within 24hrs with pain)
• Bone Scan (3-4days)-100% SENSITIVE

8. Wrist PA

11. Management of fractures
Most stable fractures can be treated with below
elbow thumb spica
Unstable fractures best treated with compression
screw fixation
• >1mm displacement
• Fragment angulation
• Abnormal carpal alignment

12. Closed treatment
•Stable non displaced fractures
•Short arm for 6-8 weeks in tubercle or distal
pole fractures
•Upto 12 weeks in waist fractures
•Position- wrist in neutral position
Nigel R.Clay, Joseph J.Dias, P.S. Costigan, P.J. Gregg, N.J. Barton. Need
The Thumb To be Immobilized In Scaphoid Fractures.

13. Complication$$
• Malunion
• AVN 15-30%

14. Distal radio-ulnar #
1. COLLES’ FRACTURE
2. SMITH’S FRACTURE
3. BARTON’S FRACTURE

15. • Osteoporotic bone
• Extra articular fracture-metaphysis involvement
• 2cm from radio carpel joint
• Look for styloid process# ulna

16. Other displacements (1/> displacements below occur in majority of the cases;
although in few cases it may be crack fracture without displacement)
oImpaction of fragments
oDorsal displacement
oDorsal tilt
oLateral displacement
oLateral tilt
oSupination

17. Clinical features:
oPain
oSwelling
oDeformity of the wrist
oOn examination;
 Tenderness
 Irregularity of the lower end of
radius
Radiological features: (Differentiated from
other fractures at the same site by looking at
the displacements)
oDorsal tilt can be detected on a lateral
X-ray:
 normal  faces ventrally
 dorsal tilt  faces dorsally or becomes
neutral
oLateral tilt can be detected on an AP X-
ray:
 normal  faces medially
 lateral tilt  faces laterally or becomes
horizontal

19. Treatment:
oUndisplaced fracture
immobilization in a below-elbow
plaster cast for 6 weeks
oDisplaced fracture manipulative
reduction followed by immobilization
in Colles’ cast

20. SMITH’S FRACTURE
• Fracture at the distal end of the radius,
at its cortico-cancellous junction, with
ventral tilt and other displacements
• Uncommon
• Treatment:
• Closed reduction
• Plaster cast immobilization (6 weeks)

22. BARTON’S FRACTURE
• Intra-articular fracture of the distal
radius
• Extends from the articular surface of the
radius to either its anterior/posterior
cortices
• The small distal fragments gets
displaced and carries with it, the carpals

23. • Displacements:
• Volar Barton’s fracture (anterior
type)
• Dorsal Barton’s fracture
(posterior type)
• Treatment:
• Closed manipulation
• ORIF with plate in cases where
closed reduction fails

24. Complications:
1.Stiffness of joints
2.Malunion
3.Subluxation of the inferior radio-ulnar joint
4.Carpal tunnel syndrome
5.Sudeck’s osteodystrophy
6.Rupture of the extensor pollicis longus tendon

26. Young guy /flextion hand fall

28. Hyperextension & fall

32. Questions?