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    Wrist Fracture – Barton’s Colles’, Smith, Carpal Fractures


    Last Updated Jan 23, 2024
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    First 5 Minutes

    All open fractures are contaminated and should receive irrigation and prophylactic antibiotics. They should be referred to a hand surgeon urgently.


    • 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?


    Recommendations based on results of peer reviewed studies in the orthopedic and plastic surgery literature.


    Related Information


    1. Smith fracture (Spaso technique) https://vimeo.com/240326467

      Below elbow backslab https://vimeo.com/240325143

    Reference List

    1. 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/

    2. 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

    3. 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

    4. Suh N, Ek ET, Wolfe SW. Carpal fractures. J Hand Surg Am. 2014 Apr;39(4):785–91; quiz 791.


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