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.
