ALL THINGS WRIST

MI Zucker, MD

A dr Z Lecture

INJURIES of the WRIST

• Fractures and ligament injuries of the distal radius and ulna and the carpal bones.

NORMAL AP

• Three smooth carpal arcs

• Inter-carpal spaces of 0-2 mm

NORMAL LATERAL

• Straight line bisecting radius-lunate-capitate

• Dorsal border-triquetrum

• Smooth dorsal and volar borders of radius and ulna

The RADIUS

The most commonly fractured wrist bone in all age groups

COLLES Fracture

Fall on outstretched hand fractures distal radius with dorsal angulation;

associated ulna styloid fracture in 2/3

SMITH Fracture

Fall on back of hand, much less common than Colles. “ Reverse

Colles”

TORUS Fracture

Most common kid fracture of the wrist. Fall on outstretched hand.

SALTER-HARRIS Injuries

SH II of the radius is most common of the wrist SH’s

SCAPHOID FRACTURES

Second most common wrist fracture, most common carpal fracture.

70 % of carpal fractures.

Watch out for additional fractures!

TRIQUETRUM Fracture

Second most common carpal fracture, but only 15 %

HAMATE HOOK Fracture

From twisting ulnar side of wrist as in golf swing

LIGAMENT INJURIES

A spectrum of injuries caused by fall on outstretched hand

SCAPHO-LUNATE DISSOCIATION

Most common, takes the least force.

Scapho-lunate distance exceeds 4 mm

PERILUNATE DISLOCATION

Interruption of three arcs on AP, loss of radius-lunate-capitate relationship

on lateral

LUNATE DISLOCATION

5 X less common than perilunate. On AP, lunate becomes triangle shaped and on lateral, radius-lunate-capitate

relationship is lost

GOODBYE

• Copyright 2004

MI Zucker, MD