Wrist Fracture – Barton’s Colles’, Smith, Carpal Fractures
Orthopedic
First 5 Minutes
All open fractures are contaminated and should receive irrigation and prophylactic antibiotics. They should be referred to a hand surgeon urgently.
Context
- The distal radius is the most common site of fracture in the upper extremity.
- Three joints make up the wrist joint: the radiocarpal joint, ulnocarpal joint, and distal radioulnar joint.
Figure 1. Wrist anatomy. https://commons.wikimedia.org/w/index.php?search=wrist+bones&title=Special:MediaSearch&go=Go&type=image. Image obtained from Wikimedia Commons.
Diagnostic Process
- History should include mechanism of injury, time since injury, and hand dominance.
- Physical exam should have components of inspection, palpation, and neurovascular screening.
- The joint above and below the area of injury is part of the examination.
- Imaging:
-
- Specific scaphoid views may be required depending on clinical picture.
- Advanced imaging with CT or MRI may be required when occult fractures are suspected.
Criteria For Transfer To Another Facility
- If required by orthopedic or plastics.
Criteria For Close Observation And/or Consult
- Surgical referral should be made for patients presenting with open fractures, or those with unstable fractures that will ultimately require surgical fixation.
- Specialist involvement also required in fractures complicated by acute neuropathy, vascular compromise, or other features.
Criteria For Safe Discharge Home
- Follow up depends on nature of injury and if conservative or surgical management was undertaken.
- Most fractures remain splinted with follow up arranged within 1 week of initial injury to reassess neurovascular status and obtain radiographs to confirm the fracture position is stable.
Quality Of Evidence?
High
We are highly confident that the true effect lies close to that of the estimate of the effect. There is a wide range of studies included in the analyses with no major limitations, there is little variation between studies, and the summary estimate has a narrow confidence interval.
Moderate
We consider that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. There are only a few studies and some have limitations but not major flaws, there are some variations between studies, or the confidence interval of the summary estimate is wide.
Low
When the true effect may be substantially different from the estimate of the effect. The studies have major flaws, there is important variations between studies, of the confidence interval of the summary estimate is very wide.
Justification
Recommendations based on results of peer reviewed studies in the orthopedic and plastic surgery literature.
Related Information
OTHER RELEVANT INFORMATION
Smith fracture (Spaso technique) https://vimeo.com/240326467
Below elbow backslab https://vimeo.com/240325143
Reference List
Hsu H, Fahrenkopf MP, Nallamothu SV. Wrist Fracture. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Dec 16]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK499972/
Search media – Wikimedia Commons [Internet]. [cited 2023 Dec 16]. Available from: https://commons.wikimedia.org/w/index.php?go=Go&search=wrist+bones&title=Special%3AMediaSearch
Distal radius fractures in adults – UpToDate [Internet]. [cited 2023 Dec 16]. Available from: https://www.uptodate.com/contents/distal-radius-fractures-in-adults?search=wrist%20fracture
Suh N, Ek ET, Wolfe SW. Carpal fractures. J Hand Surg Am. 2014 Apr;39(4):785–91; quiz 791.
RESOURCE AUTHOR(S)
DISCLAIMER
The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of patients in the emergency department. This summary was produced by Emergency Care BC (formerly the BC Emergency Medicine Network) and uses the best available knowledge at the time of publication. However, healthcare professionals should continue to use their own judgment and take into consideration context, resources and other relevant factors. Emergency Care BC is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. Emergency Care BC also assumes no responsibility or liability for changes made to this document without its consent.
Last Updated Jan 23, 2024
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