This web site has been
authored by Mr G J Packer, an Orthopaedic Surgeon specialising in wrist injuries, and is
intended as a source of information and communication for other medical consultants,
healthcare professionals and for patients.
The presentation has been organised into several sections accessed
via the links to the left. To see the full presentation on one page, please click here.
Fractures of the Wrist
Fractures of the wrist are very
common injuries. Around one quarter of all patients in a Fracture
Clinic will have suffered a fracture of the wrist.
Fractures of the wrist are commonly given names after
the Doctors who first described them. The commonest type is a
COLLES’ fracture but you may also hear terms such as SMITH’S and
BARTON’S fracture. These days, Orthopaedic surgeons tend not to use
these terms but to classify these fractures according to their
prognosis, that is how severe the injury to the bone and wrist joint
There are many classifications for fractures of the
distal radius. One of the commonest is that according to FRYCKMANN
who is a Swedish Orthopaedic Surgeon who described a fracture
classification system based upon the parts of the joint that were
involved. What he says, and this has been borne out by experiments
since this time, is that the more parts of the joint surface that
are involved, the more likely the fracture was to result in a poor
The usual cause of a fracture of the wrist is a fall. The person
falling tries to break their fall by putting their hand out to save
themselves and in doing so, the wrist is forced backwards (figure
Figure one: A fall onto the
outstreched hand is the usual cause of fractures of the wrist joint. Click here to view a larger version.
The break or fracture usually occurs about 2.5cm from
the wrist joint at the point where the radius (the largest of the
two bones of the forearm) starts to narrow to form the broad and
relatively soft (concellous) bone forming the joint to the hard
(cortical) bone in the shaft of the radius (figure two).
Figure two: How and why wrist
fractures occur. Click here to view a
With more severe force the fracture may extend into
either or both of the main joints which allow the wrist to move.
These joints are the radio-carpal joint and the distal radio-ulnar
joint (figure three). When fractures involve joints (what is
known as an intra-articular fracture) they can cause stiffness of
the joint and if the surface of the joint becomes uneven, this may
result in arthritis of the joint. There is another problem
associated with wrist fractures which is that there are two bones
that make up the wrist joint, the radius and the ulna. In most
people these bones are approximately the same length (figure
Figure three: Tracing of a normal
wrist seen from the front to show normal features and the site of fracture. Click here to view a larger version.
When a fracture of the wrist occurs
the commonest scenario is that the radius will become short when
compared to the ulna. This is because the dorsal comminution
(see figure two) results in a space into which the radius can
settle back as the fracture heals. This results in shortening of
the radius in comparison to the ulna and the ulna may then
effectively become longer so that when the wrist moves it causes
pain and restriction of movement.
The commonest form of fracture of the wrist causes
the radius to bend away from the palm. The patient may therefore
notice a change in the shape of the wrist which is called the
“dinner fork” deformity after its shape. This is a deformity of the
COLLES’ fracture (figure four).
Figure four: Wrist fracture (X-ray)
seen from the side view to show "dinner fork" deformity of Colles
fracture. Click here to view a larger