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What are Complex Wrist and Hand Fractures?

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Complex wrist and hand fractures are high energy injuries of the wrist and hand with articular disruption, ligament injuries, neuromuscular instability and soft tissue injuries.

A few common complex wrist and hand fractures are:

  • Distal radius and ulna fracture- fracture in the distal end of the radius and ulna (forearm bones)
  • Scaphoid fracture- fracture of the largest carpal bone
  • Ulnar styloid fracture-fracture in the ulnar styloid joint (visible bulge on the outside wrist)
  • Radial styloid fracture (Chauffer’s fracture)- fracture in the radial styloid joint (base of the thumb)
  • Radio carpal joint fracture (Barton’s fracture)-dislocation of the radio carpal joint along with distal radius fracture

What Causes Complex Wrist and Hand Fractures?

Some of the common causes of complex wrist and hand fracture include:

  • Trauma
  • Outstretched hand in an attempt to break a fall
  • Sports injuries
  • Road accidents
  • Mechanical injuries
  • Osteoporosis (a disorder in which the bones become very fragile and more likely to break, common in elderly adults over 60 years)
  • Women usually after menopause with low calcium are more susceptible

What Structures are Involved in Complex Wrist and Hand Fractures?

  • There are two long bones of the forearm, the radius on the thumb (lateral) side and the ulna on the little finger (medial) side. The distal end of the bones is mostly involved.
  • The two rows of carpel bones but mostly the scaphoid (base of the thumb), lunate and pisiform (base of the little finger) are commonly involved.

What are the Signs and Symptoms of Complex Wrist and Hand Fractures?

  • Intense pain which is not relieved by medications
  • Bruising (bluish/blackish discoloration) over the wrist
  • Swelling over the wrist
  • Tenderness
  • Bleeding in cases of open fracture
  • Wrist or hand hanging in an odd way
  • Fingers turn pale and numb
  • Limited movement and stiffness

Diagnosing Complex Wrist and Hand Fractures

Diagnosis of the type of fracture in the wrist and hand injury plays a major role in the treatment planning which is based on the fracture location, severity, age of the patient and mobility of the hand. It is important to correctly identify the type of fracture because there is a risk of deformity or even a loss of limb due to complications, if not treated properly. Your doctor will order X ray’s and a CT scan, and rarely an MRI scan to confirm the bone break & surrounding tissue injuries.

How are Complex Wrist and Hand Fractures Treated?

The main goal of treatment for these type of fractures is to realign the broken pieces into proper anatomical position and preventing dislocation until healing has occurred. The choice of treatment by the orthopedist will depend on the evaluation measures.

Surgical management

  • With open and comminuted fractures, immediate surgical intervention is typically required within 24 hours following the injury.
  • The exposed soft tissue and bones are cleaned and an external fixator or splint is applied to avoid heavy blood loss and antibiotics will be administered to avoid infections.
  • An incision will be made on the wrist over the fracture site to assess the broken bone under the influence of anesthesia in the operating room. Vital structures like blood vessels, nerves, tendons and ligaments are carefully preserved.
  • The broken bones are realigned, and any torn ligaments are repaired through the incision. This process is known as an open reduction.
  • If the bone is in position, then straightened manually without an incision, it is known as a closed reduction.
  • Plates and screws, wires, metal pins and external applicators or a combination of these techniques are applied according to the patient’s condition, and the incision is closed and covered with a bandage.
  • Dressings and suture removal will be scheduled at a follow-up visit. A cast or wrist support is advised to support the hand for 2-3 weeks.

Post-operative recovery

During the recovery phase, the following precautions are advised:

  • Active finger movements and physical therapy exercises
  • Minimal or no water exposure to promote wound healing
  • Non-weight bearing activities
  • Rest for at least 6-8 weeks
  • Resume regular activities after 8 weeks

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