Fractures of the Wrist by Mr G J Packer, Orthopaedic Surgeon in Essex, UK.

 
Introduction

Wrist fracture x-ray.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 is.

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 outcome.

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 one)

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.
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 larger version.
Figure two: How and why wrist fractures occur. Click here to view a larger version.

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 three).

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.
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 Colle’s fracture. Click here to view a larger version.
Figure four: Wrist fracture (X-ray) seen from the side view to show "dinner fork" deformity of Colle’s fracture. Click here to view a larger version.

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This page was last updated on 03/Oct/2007