eMedicine Specialties > Plastic Surgery > Hand

Hand, Wrist Fractures and Dislocations: Follow-up

Author: Michael Morhart, FRCSC, MD, MSc, Associate Clinical Professor, Department of Surgery, University of Alberta; Chief of Division of Plastic Surgery, Royal Alexandra Hospital
Coauthor(s): Edward E Tredget, MD, MSc, FRCSC, Professor, Department of Surgery, University of Alberta, Director, Firefighters Burn Treatment Unit, University of Alberta Hospital, Director, Plastic Surgery Wound Healing Reserach Laboratory, University of Alberta; Abdulaziz T A Jarman, MBBS, Attending Plastic Surgeon, Royal Alexandra Hospital; Faculty, Division of Plastic Surgery, Department of Surgery, University of Alberta Faculty of Medicine and Dentistry; Ali Ghahary, BSc, MD, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Alberta
Contributor Information and Disclosures

Updated: Oct 6, 2008

Outcome and Prognosis

Most wrist injuries have a positive outcome if diagnosed and treated early. Complications and late presentation can lead to devastating degenerative changes in the wrist.

Future and Controversies

Arthroscopy

An important trend in the management of wrist fractures and dislocation is the use of wrist arthroscopy. Arthroscopy, though initially intended as a diagnostic tool, has increasing application as a therapeutic tool also. This includes soft tissue repair (interosseous ligaments and the TFCC) as well as bony repair (ORIF of scaphoid). Its benefit will lead to more accurate reduction of structures and, potentially, less down time for patients. This is an active field of study and growth and appears to have tremendous potential.

Revascularization

Revascularization techniques such as vascular bone grafting for avascular necrosis of the scaphoid and lunate have been described and developed by a variety of researchers. Although successes have been reported using these methods, a final consensus has not been reached on the efficacy of these techniques. However, the use of these techniques continues to grow; they are becoming important tools among practicing hand surgeons' current armamentarium.

Salvage

Regarding Kienböck disease, researchers have not yet determined which salvage procedure is the most efficacious for end-stage carpal collapse. However, weighing the benefits of pain management versus the loss of function, or vice versa, may ultimately remain the patient's burden. Certainly, proximal row carpectomy, if available, is at the top of the list. Total wrist fusion is an alternative option.

Electrical stimulation

Pulsed electromagnetic stimulation with small, implanted electrodes has been described for the treatment of scaphoid nonunion sites. This osteosynthetic technique remains controversial but is advocated by some in instances in which alternate methods of treating nonunion have failed.

 


More on Hand, Wrist Fractures and Dislocations

Overview: Hand, Wrist Fractures and Dislocations
Workup: Hand, Wrist Fractures and Dislocations
Treatment: Hand, Wrist Fractures and Dislocations
Follow-up: Hand, Wrist Fractures and Dislocations
Multimedia: Hand, Wrist Fractures and Dislocations
References
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Further Reading

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Keywords

fractured wrist, broken wrist, dislocated wrist, scaphoid fracture, dorsal intercalated segment instability, DISI, scaphoid waist fractures, avascular necrosis, AVN, lunate fracture, scaphoid dislocation, lunate dislocation, Kienbock disease, Kienbock's disease, transcarpal injury, perilunate dislocation, fracture dislocation, perilunate fracture dislocation, carpal fracture, transscaphoid disruption, trans-scaphoid disruption, transcapitate disruption, trans-capitate disruption, transtriquetral disruption, trans-triquetral disruption, axial dislocation, axial fracture dislocation, axial-radial-ulnar dislocation, axial-radial dislocation, triquetral fractures, pisiform fractures, hamate fractures, scaphocapitate syndrome

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Contributor Information and Disclosures

Author

Michael Morhart, FRCSC, MD, MSc, Associate Clinical Professor, Department of Surgery, University of Alberta; Chief of Division of Plastic Surgery, Royal Alexandra Hospital
Michael Morhart, FRCSC, MD, MSc is a member of the following medical societies: American Society for Surgery of the Hand and Canadian Society of Plastic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Edward E Tredget, MD, MSc, FRCSC, Professor, Department of Surgery, University of Alberta, Director, Firefighters Burn Treatment Unit, University of Alberta Hospital, Director, Plastic Surgery Wound Healing Reserach Laboratory, University of Alberta
Disclosure: Nothing to disclose.

Abdulaziz T A Jarman, MBBS, Attending Plastic Surgeon, Royal Alexandra Hospital; Faculty, Division of Plastic Surgery, Department of Surgery, University of Alberta Faculty of Medicine and Dentistry
Disclosure: Nothing to disclose.

Ali Ghahary, BSc, MD, Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Alberta
Disclosure: Nothing to disclose.

Medical Editor

Milton B Armstrong, MD, FACS, Associate Professor of Clinical Surgery, Associate Professor of Clinical Orthopedics, Department of Surgery, University of Miami Miller School of Medicine
Milton B Armstrong, MD, FACS is a member of the following medical societies: American Association for Hand Surgery, American Association of Plastic Surgeons, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, American Society for Reconstructive Microsurgery, American Society for Surgery of the Hand, and National Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David W Chang, MD, FACS, Associate Professor, Department of Plastic Surgery, MD Anderson Cancer Center, The University of Texas
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Subhas Gupta, MD, PhD, CM, FRCS(C), FACS, Professor of Surgery, Chair, Department of Plastic Surgery, Director of Plastic Surgery Residency, Director of Comprehensive Wound Service, Department of Plastic Surgery, Loma Linda University School of Medicine
Subhas Gupta, MD, PhD, CM, FRCS(C), FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Phlebology, American College of Surgeons, American Medical Association, American Medical Informatics Association, American Society of Plastic Surgeons, California Society of Plastic Surgeons, Canadian Medical Association, Canadian Society of Plastic Surgeons, Canadian Society of Plastic Surgeons, College of Physicians and Surgeons of Ontario, Plastic Surgery Research Council, Quebec Medical Association, Royal College of Physicians and Surgeons of Canada, and Wound Healing Society
Disclosure: Nothing to disclose.

 
 
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