Fractures around the Wrist

• Fractures around the Wrist:

  • very common injury:
  • about 20% of all fractures presenting to A&E
  • typically occurs due to FOOSH
  • position of the wrist at the moment of hitting the ground will affect:
  • the form and severity of the fracture of the distal radius
  • the concomitant injury of disco-ligamentary structures of the wrist
• Fractures around the Wrist:

  A) Colles Fracture

  B) Smiths Fracture

  
• Complications with Fractures:

  • mal-union - abnormal healing of bone
  • non-union - bone doesnt heal
  • delayed-union - bone heals slower than expected
  • deconditioning, weakness and loss ROM in hand
  • DRUJ subluxations/dislocations/instability
  • oedema/compartment syndrome - can lead to compression affecting blood supply to areas distal to injury
  • triangular fibrocartilage complex (TFCC) injury
  • tendon injury
  • complex regional pain syndrome (CRPS) - can be present in up to 40% of people following a wrist fracture
  • peripheral nerve injury
  • more proximal injury (Monteggias and Galeazzi fractures)
• Complications with Fractures - Monteggia & Galeazzi Fractures:

  • fracture of the proximal third the ulna and dislocation of the radial head
  • fracture of the radius with shortening and dislocation of the distal ulna
• Rehab of Fractures:

  • liaise closely with the orthopaedic team:
  • complications
  • contraindications
  • restrictions
  • maintain conditioning of non-injured areas i.e. upper limb and lower limb strength and cardio fitness
  • prevent and reduce oedema
  • manage, monitor pain and sensation
  • restore ROM and strength
  • restore dynamic strength and function
  • review cause for injury - balance retraining