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Carpal Bone Injuries Follow-up

  • Author: Bryan C Hoynak, MD, FACEP, FAAEM; Chief Editor: Sherwin SW Ho, MD  more...
 
Updated: Jan 11, 2016
 

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See the list below:

  • Distal radius fracture: Uncomplicated fractures require conversion of the splint to a short-arm cast for 6-8 weeks once swelling has abated. An orthopedic specialist should assess the limb for adequate alignment and the need for operative intervention.
  • Scaphoid fracture: Treatment in a thumb spica cast for 12 weeks results in healing for 90% of these fractures.
  • Lunate fracture: Most lunate fractures heal with placement of a spica cast for 10-12 weeks.
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Complications

See the list below:

  • Most complications from wrist fractures occur when the distal radius is fractured.
  • Colles fractures may result in radial shortening and angulation deformity, subluxation of inferior radioulnar joint, reflex sympathetic dystrophy, median nerve injury, osteoarthritis, or ulnar impaction syndrome.
  • Radiocarpal fracture-dislocation may cause entrapment of tendons or the ulnar nerve and/or artery.
  • A Hutchinson fracture may result in scapholunate dislocation, osteoarthritis, or ligament damage.
  • A Smith fracture may result in a complication similar to that of a Colles fracture.
  • Ulnar styloid fractures often result in nonunion.
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Prevention

Wrist protection with support in the axial plane (with volar and dorsal hard-surface materials) is vital to prevent carpal injures in such sports as inline skating (ie, rollerblading).

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Prognosis

The prognosis depends on the severity of the injury and whether surgical correction is required. For example, simple, nondisplaced fractures of the distal radius require approximately 6 weeks of immobilization and 4-6 weeks of rehabilitation for a return to the full, premorbid condition. However, fracture-dislocations of the wrist that require open reduction and internal fixation require 8-12 weeks for the initial treatment phase and a similar amount of time for rehabilitation.

The prognosis following wrist fractures is influenced by many variables, including the complexity of the injury. Open fractures with large soft-tissue injuries have a much poorer prognosis. Additionally, timely and appropriate care can improve the prognosis. Appropriate follow-up monitoring and aggressive rehabilitation are essential.

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Education

When a patient is reintroduced to a sporting activity, in order to avoid reinjury and protect the injury site, take into account the patient's overall athletic strength when formulating an approach. For example, a tennis player with a carpus injury must regain full strength before attempting full use of the injured wrist during play. Specific care to the wrist-supporting ligaments and muscles is necessary to prevent overuse injuries during recovery and return of function.

For patient education resources, see the Hand, Wrist, Elbow, and Shoulder Center, Arthritis Center, and Breaks, Fractures, and Dislocations Center, as well as Carpal Tunnel Syndrome and Wrist Injury.

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Contributor Information and Disclosures
Author

Bryan C Hoynak, MD, FACEP, FAAEM Associate Clinical Professor of Emergency Medicine, University of California at Irvine School of Medicine; Director of Emergency Services, Chairman of Division of Emergency Medicine, Placentia-Linda Hospital

Bryan C Hoynak, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Burn Association, American College of Surgeons, American Heart Association, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Russell D White, MD Clinical Professor of Medicine, Clinical Professor of Orthopedic Surgery, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center-Lakewood

Russell D White, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association of Clinical Endocrinologists, American College of Sports Medicine, American Diabetes Association, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

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