Wrist Fractures

Forearm Backslab (Volar Wrist Half Cast) Elevation of the Limb

  1. Apply basic ATLS principles and consider that the mechanism of fall might have been secondary to a cardiovascular or a cerebrovascular incident.
  2. If there is any stigmata of compartment syndrome or vascular threatened limb, refer immediately.
  3. Consider the whole upper limb.
    • Screen the neck.
    • Screen the Brachial Plexus.
    • Screen the shoulder.
    • Screen the elbow.
  4. If it is a severe dinner fork deformity with dorsal displacement with median nerve symptoms, reduce and realign under sedation and apply a volar backslab (half cast).
  5. If a wrist injury only: Order PA and Lateral x-ray views of the wrist (not the forearm).
  6. If a wrist injury with tender elbow (consider Essex Lopresti type injury) order PA and Lateral wrist as well as AP and Lateral Elbow x-ray views

Consider X-Rays

  1. Use the rule of elevens as a rough guideline deciding whether the patient needs to have some corrective intervention.
  2. If the fracture is undisplaced and within the boundaries of the rule of elevens, a volar wrist backslab can be applied and the patient can be seen by an orthopaedic surgeon within 48 hours.
  3. If no fracture is seen, consider a scaphoid fracture, scapho-lunate ligament or distal radio-ulnar joint injury with or without a TFCC (triangular fibro-cartilage complex) injury. These injuries can be splinted with a volar backslab and safely re-evaluated by an orthopaedic surgeon within 48 hours.

Rules of Eleven

  1. On the lateral, consider inclination of C-shaped lunate fossa of the radius. It should have a 11° volar inclination. With the Colle’s type fracture it tends to “fall” back. Neutral position is acceptable. 11° dorsal displacement (already displaced 22°) needs a reduction.
  2. On the PA view, the radial styloid should be 11mm higher than the ulna plateau. With impaction this height gets shortened.
  3. On the PA view, the radial inclination should be 22°. This angle gets reduced in an impacted fracture.

inclination of C-shaped lunate fossa of the radius radial inclination radial styloid

Definitive Management

Surgically managed wrist fractures x-ray of surgically managed wrist fractures

Rehabilitation principles