Wrist and Scaphoid

Index case term 1

Anatomy

• Can you name all these bones?

Clinical Case 1

• 85 year old woman

• Falls over and lands on outstretched arm

• Pain in wrist

• Tender over base of thumb and wrist

• What are possible injuries?

X-ray of wrist

Distal Radial FractureColles Fracture

Colles fracture of wrist

• How is this injury treated?

• What long term complications may the patient experience?

• What can be offered to help reduce these complications?

Post manipulation x-ray

Wrist fractures

• 3 types

• Depends on what position the hand is forced into by the fall

• Depends on displacement of distal radius and whether the wrist joint is involved

Smiths fracture

Barton’s fracture

Clinical case 2

• 8 year old child

• Falls onto outstretched arm whilst skateboarding

• Not using arm

• Tender over wrist on examination

• What is most likely injury?

Greenstick fracture of distal radius

Clinical case 3

• 25 year old man

• Falls over handlebars whilst mountain biking

• Attends A and E

• Tender over base of thumb and wrist

Scaphoid views on x-ray

Scaphoid Fracture

Scaphoid fracture

• Fall on outstretched hand

• Tender in anatomical snuffbox

• Usually fractures through the waist of Scaphoid

• Complications???

Blood supply to Scaphoid

Avascular necrosis of scaphoid

• Affects proximal pole of scaphoid

• Bone may fragment• Causes secondary

degenerative pain

What if X-ray normal?

• If clinically suspect scaphoid fracture

• Treat as fracture and repeat x-ray in fourteen days time when fracture maybe more apparent

• Image wrist with MRI as will show subtle fractures, bone oedema, and ligamentous injury

MRI of Scaphoid fractureT1 weighted T2 weighted fat sat

showing oedema in distal scaphoid

Wrist and hand

• In Summary, we have looked at

• Anatomy

• Common injuries

• Complications of injury