This presentation covers wrist fractures, highlighting their common occurrence and potential for significant disability if untreated. It details the mechanisms of injury, types of fractures (Colles, Smith, Barton), and emphasizes the importance of identifying subtle injuries like scaphoid fractures and dislocations. The presentation also instructs on recognizing dislocations and the critical role of accurate diagnosis and follow-up imaging.

1. WRIST FRACTURES
A PRESENTATION BY THE CASUALTY
CREW

2. TEXT
WHY SHOULD WE KNOW ABOUT THESE FRACTURES
▸ THESE ARE SOME OF THE MOST COMMON FRACTURES
SEEN
▸ THEY ARE ALSO SOME OF THE MOST EASILY MISSED
▸ CAN LEAD TO SIGNIFICANT DISABILITY IF UNTREATED
▸ VERY EASY TO IDENTIFY ONCE YOU KNOW WHAT TO
LOOK FOR

3. A NORMAL
WRIST
‣ CAN YOU NAME THE BONES?
‣ NOTE THE 3 ARCS YOU SHOULD CHECK FOR
‣ NOTE THE NORMAL DISTANCES BETWEEN THE
CARPAL BONES
S
L
T
P
R U
TR TR
C
H

4. THE ZONE OF VULNERABILITY
MOST FRACTURES/DISLOCATIONS WILL OCCUR HERE
▸ MOST INJURIES ARE DUE TO FOOSH (FALL ON
OUT STRETCHED HAND)
▸ AS YOU PROGRESS FROM RADIUS TO ULNAR
SIDE, THE SEVERITY OF INJURY INCREASES BUT
THE FREQUENCY DECREASES
▸ I.E, A RADIAL STYLOID # IS COMMON BUT NOT
SEVERE
▸ AN ULNAR STYLOID FRACTURE IS LESS COMMON
BUT MORE SEVERE
▸ A SCAPHOID WAIST # IS MORE COMMON THAN A
HAMATE #, BUT THE HAMATE # IS A MORE SEVERE
INJURY (GOT IT?!)
▸ THIS APPLIES TO DISLOCATIONS/ FRACTURE-
DISLOCATIONS AS WELL

5. NOW FOR SOME
FRACTURES
LET START WITH EASY ONES

6. 1
2
3

7. COLLES #
NOTE THAT THE DISTAL
RADIUS IS DISPLACED
POSTERIORLY

8. SMITHS #
NOTE THAT THE DISTAL
RADIUS IS DISPLACED
ANTERIORLY

9. BARTONS #
NOTE THAT THERE IS RADIO-
CARPAL SUBLAXATION
THIS A VOLAR TYPE

10. NAME THE #
WHICH WAY DOES THE
DISPLACEMENT GO?

11. NAME THE #
WHICH WAY DOES THE
DISPLACEMENT GO?

12. FIND THE FRACTURE
WAS IT DIFFICULT?
▸ HOW COMMON IS IT?
▸ HOW SEVERE IS IT?

13. FIND THE #
WAS IT DIFFICULT?
▸ HOW COMMON IS IT
▸ HOW SEVERE IS IT

14. LETS TRY SOME
CARPAL BONE #’S

15. FIND THE FRACTURE
WHAT IS IT CALLED?
▸ HOW COMMON IS IT
▸ HOW SEVERE IS IT
▸ WHAT IS THE DANGER OF THIS #

16. FIND THE FRACTURE
WAS IT DIFFICULT?
▸ THESE FRACTURES CAN BE
SUBTLE
▸ CHECK FOR PAIN IN THE
ANATOMICAL SNUFFBOX
▸ IF YOU ARE UNSURE THEN
BETTER TO PUT IN A POP AND RE
X-RAY IN 10-14 DAYS

17. LETS FIND SOME
FRACTURES

19. BENNETS #

20. ONE MORE SET
FOR FUN

22. TRIQUITRAL #
HAMATE #
SCAPHOID #
WHICH IS THE MOST COMMON?
WHICH IS THE MOST SEVERE?

23. LETS DO SOME
DISLOCATIONS

24. A NORMAL LATERAL
VERY IMPORTANT FOR ASSESSING DISLOCATIONS
▸ CAN YOU NAME WHAT YOU SEE?
▸ C- CAPITATE , SITS IN THE L-
LUNATE, SITS IN THE R-RADIUS
▸ APPLE (C) SITS IN THE CUP (L) SITS
IN THE SAUCER (R)
C
L
R

25. WHAT IS OUT OF
PLACE?
COMPARE TO THE
PREVIOUS IMAGE

26. CAN YOU SEE IT NOW
THIS IS A LUNATE DISLOCATION
▸ THE LUNATE (CUP) IS DISPLACED
FROM THE RADIUS (SAUCER)
▸ THE CAPITATE MAY BE IN
VARIOUS POSITIONS BUT IS
GENERALLY POSTERIOR

27. WHAT IS OUT OF
PLACE?
THINK OF THE APPLE,
CUP AND SAUCER

28. CAN YOU SEE IT NOW?
THIS IS A PERILUNATE DISLOCATION
▸ THE CAPITATE (APPLE) HAS
DISLOCATED FROM THE LUNATE
(CUP)
▸ BUT THE LUNATE (CUP) IS STILL
ATTACHED TO THE RADIUS
(SAUCER)
▸ EASY?

29. THE DIAGNOSIS IS NOT
IMPORTANT
CAN YOU SEE THE
DISPLACEMENTS

30. NOT SO DIFFICULT IS IT!
THIS IS A MIDCARPAL DISLOCATION
▸ BOTH THE CAPITATE AND
LUNATE ARE DISPLACED
▸ THE MOST IMPORTANT THING IS
TO SPOT THE DISPLACEMENT,
THE FINAL DIAGNOSIS IS MADE
BY AN ORTHOPAEDIC SPECIALIST
▸ BUT THEY WILL BE IMPRESSED IF
YOU PICK IT UP

31. FINALLY
THIS IS A SCAPHO-LUNATE DISSOCIATION
▸ NOTE THE WIDE SPACE BETWEEN
THE SCAPHOID AND THE LUNATE
▸ CAUSES AN UNSTABLE WRIST
▸ VERY EASY TO MISS
▸ SEVERE PAIN ON MOVEMENT IN
THE ABSENCE OF A # SHOULD
MAKE YOU GO BACK AND
CHECK FOR THIS