Acute Bony Injuries of Hand and Wrist

Acute bony injuries to the hand and wrist are very common after a fall on an outstretched hand. In the wrist, distal radius fractures are the most common; isolated distal ulna fractures are uncommon. More serious injuries to the wrist include complicated fracture-dislocation injuries such as perilunate dislocations. At the carpal level, scaphoid fractures are the most common followed by fractures of the dorsal side of the triquetrum. The metacarpals often fracture, most commonly the base of the thumb and the subcapital region of the fifth metacarpal. In the fingers, we encounter many different types of fractures, often avulsions reflecting underlying soft tissue pathology (e.g., mallet finger). Dislocations are common in the fingers, predominantly in the distal interphalangeal joints. From an imaging standpoint, conventional radiography is always the initial examination. Complex (intra-articular) fractures, fracture-dislocation injuries, and a strong clinical suspicion of radiographically occult fractures need to be further evaluated for decision making regarding treatment. Computed tomography is the primary imaging modality of choice for the first two. In the latter, magnetic resonance imaging can be preferable, depending on clinical suspicion and the local situation in the associated hospital.