Fractures and dislocations of the wrist

Wrist injuries are and will continue to be one of the most difficult and interesting orthopedic problems encountered by emergency physicians. With a knowledge of basic wrist anatomy, the gathering of a detailed history of the mechanism of injury, thorough physical examination, and appropriate radiography, the physician will be able to make an accurate early diagnosis. This will prevent the development of serious functional problems such as osteonecrosis or malunion with all their attendant pain and disability, which is especially serious for the young active worker or athlete. A thorough radiographic examination should be done, the six-view series being the most revealing initial study, particularly for possible scaphoid fractures. All injured wrists should be properly immobilized and re-evaluated if a fracture or serious ligamentous injury is at all suspected. An appreciation of the simplicity of design and remarkable functional complexity of the wrist together with a respect for the subtlety of presentation of injury will help the emergency physician to ensure that patients have highest standard of care and an excellent outcome.