Fractures of the Hand and Wrist

Fractures of the Hand and Wrist

The most commonly fractured sites of the human skeletal system occur at the hand and wrist complex. Attaining the necessary skills to properly manage these injuries is vital so that potentially debilitating conditions are prevented. When caring for injuries to the hand and wrist complex, preserving function opposed to form takes precedence. Although all injuries to the hand and wrist deserve prompt examination and treatment, only open fractures and dislocations are considered true orthopedic traumatic emergencies. Conservative emergency medical care consists of splinting the injured hand and wrist complex in a position of function and immediately transporting the athlete to the nearest hospital.

Fractures of the Forearm

The most common type of distal radial fracture is the Colles’ fracture, which is most often associated with falling on an outstretched arm with the wrist in extension. The force associated with this mechanism of injury tends to displace fractured fragments dorsally. A Colles’ fracture must be dealt with meticulously because severe morbidity may result from improper management.An additional traumatic distal radial fracture is known as the Smith’s fracture. This particular fracture is noted by volar displacement of distal fragments following injury. The mechanism of injury usually associated with a Smith’s fracture is characterized by falling on an outstretched arm with the wrist in flexion. A Smith’s fracture tends to be considerably unstable and requires urgent referral to an orthopedic specialist for consultation.

Suitable treatment for Colles’ and Smith’s fractures requires careful immobilization by application of a forearm splint in the position of presentation so as not to exacerbate angulation of fractured fragments. Activation of EMS may be necessary to facilitate transport to the nearest hospital. While awaiting arrival of EMS, the athletic trainer must periodically monitor neurovascular function of the affected extremity. The athletic trainer should also be attentive for symptoms of acute compartment syndrome and shock. Radial and ulnar shaft fractures are most often the result of a significant direct force. Radial shaft fractures are more prevalent at the middle and distal third because of the decreased cross-sectional area of the musculature. Management of displaced forearm fractures requires immobilizing the area, including the wrist and elbow joints, in the position found with a rigid splint. Immediate transport to the nearest emergency medical facility is also mandated for proper follow-up care. Management of forearm skeletal fractures must stress evaluation of the elbow and wrist joints for associated injury. Most important is assessing sensorimotor distribution of the radial, median, and ulnar nerves along the forearm and hand. The athletic trainer must intermittently monitor neurovascular functions of the injured extremity and constantly screen for signs of acute compartment syndrome and shock while awaiting definitive care.

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