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ALL THINGS WRIST
MI Zucker, MD
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A dr Z Lecture
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INJURIES of the WRIST
• Fractures and ligament injuries of the distal radius and ulna and the carpal bones.
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NORMAL AP
• Three smooth carpal arcs
• Inter-carpal spaces of 0-2 mm
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NORMAL LATERAL
• Straight line bisecting radius-lunate-capitate
• Dorsal border-triquetrum
• Smooth dorsal and volar borders of radius and ulna
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The RADIUS
The most commonly fractured wrist bone in all age groups
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COLLES Fracture
Fall on outstretched hand fractures distal radius with dorsal angulation;
associated ulna styloid fracture in 2/3
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SMITH Fracture
Fall on back of hand, much less common than Colles. “ Reverse
Colles”
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TORUS Fracture
Most common kid fracture of the wrist. Fall on outstretched hand.
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SALTER-HARRIS Injuries
SH II of the radius is most common of the wrist SH’s
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SCAPHOID FRACTURES
Second most common wrist fracture, most common carpal fracture.
70 % of carpal fractures.
Watch out for additional fractures!
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TRIQUETRUM Fracture
Second most common carpal fracture, but only 15 %
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HAMATE HOOK Fracture
From twisting ulnar side of wrist as in golf swing
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LIGAMENT INJURIES
A spectrum of injuries caused by fall on outstretched hand
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SCAPHO-LUNATE DISSOCIATION
Most common, takes the least force.
Scapho-lunate distance exceeds 4 mm
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PERILUNATE DISLOCATION
Interruption of three arcs on AP, loss of radius-lunate-capitate relationship
on lateral
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LUNATE DISLOCATION
5 X less common than perilunate. On AP, lunate becomes triangle shaped and on lateral, radius-lunate-capitate
relationship is lost
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GOODBYE
• Copyright 2004
MI Zucker, MD