Hand and Wrist (Brief Note)

Fractures and dislocations are particularly important in the wrist, as considerable incapacitation with osteoarthritis can result from delayed treatment. Note that fractures of the scaphoid may not show for 10 days following the injury. If a fracture of the waist of the scaphoid is mistreated, ischaemic necrosis of the distal fragment may result. It is important to learn the normal appearance of the positions of the carpal bones so that dislocations are not overlooked. Common fracture sites include the following: fracture of the distal radius and ulna with backward displacement (Colles' fracture); forward displacement of this fracture may occur which is relatively rare (Smith's fracture); fracture of the base of the first metacarpal (Bennett's fracture). Spiral fractures of the metacarpals and distal shaft fractures of the fourth and fifth metacarpal bones may follow a punch! Note that many systemic diseases have bony and soft tissue abnormalities which can be seen on a hand x-ray, e.g. hyperparathyroidism, scleroderma and rheumatoid arthritis.

Wrist PA View