CURRENT CONCEPTS IN ADULTS UPPER EXTREMITY FRACTURES

21452Ugur_TiftikciCurrent_Consept_in_adults.kapak

WRIST FRACTURES: EVALUATION AND MANAGEMENT

Ali Said Nazlıgül

Ankara Sincan Training and Research Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye

Nazlıgül AS. Wrist Fractures: Evaluation and Management. In: Tiftikçi U, Erdoğan E, Ergün C, Güneş Z, editors. Current Concepts in Adults Upper Extremity Fractures. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.263-269.

ABSTRACT

Wrist fractures, particularly distal radius fractures, are among the most commonly encountered musculoskeletal injuries in emergency departments. They primarily occur due to low-energy trauma in older individuals, such as falls from standing height. However, in younger populations, wrist fractures are often the result of high-energy trauma, like injuries sustained during athletic activities or vehicle accidents. The most common types of distal radius fractures include Colles, Smith, and Barton fractures, each with unique fracture patterns depending on the direction and force of the trauma. Accurate diagnosis and appropriate treatment are essential for ensuring optimal recovery and reducing the risk of complications.

Accurate evaluation of wrist fractures requires a thorough clinical examination and appropriate imaging. Physical examination should assess for swelling, deformity, tenderness, and neurovascular status, with particular attention to potential median nerve compression in displaced fractures. A detailed radiographic assessment, including anteroposterior, lateral, and oblique views, is essential for identifying fracture patterns and assessing the extent of the injury. In cases where more detailed visualization is required, such as in intra-articular or comminuted fractures, computed tomography may be necessary. Additionally, clinicians should be mindful of possible associated soft tissue injuries, including ligament and tendon damage, which can complicate the overall management of the injury.

Management strategies for wrist fractures vary based on the fracture’s severity, displacement, and whether it is open or closed. Non-displaced fractures are typically managed conservatively through immobilization with a splint or cast. In cases of displaced fractures, reduction is required to realign the bone fragments, followed by immobilization. If reduction cannot be maintained or if the fracture is unstable, surgical intervention may be necessary, including internal or external fixation. Open fractures, which present a significant risk of infection, require urgent debridement, antibiotic therapy, and often surgical stabilization. The Gustilo and Anderson classification is widely used to guide treatment decisions by assessing the severity of soft tissue injury in open fractures.

Complications of wrist fractures can arise early or late in the treatment process. Early complications include median nerve injury, compartment syndrome, and vascular injury, which require prompt identification and intervention to prevent permanent damage. Late complications may involve tendon irritation or rupture, osteoarthritis, malunion, or nonunion. Reduced wrist function, including pain, instability, and reduced range of motion, can also occur, particularly in cases where fractures heal improperly. Timely follow-up with imaging is essential to ensure proper healing and to address any complications as they arise.

Keywords: Wrist injuries; Radius fractures; Fractures bone; Fractures open; Carpal bones

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