Carpal Bone Injuries Follow-up
- Author: Bryan C Hoynak, MD, FACEP, FAAEM; Chief Editor: Sherwin SW Ho, MD more...
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- 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.
Complications
- 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.
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).
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.
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 excellent patient education resources, visit eMedicine's Hand, Wrist, Elbow, and Shoulder Center, Arthritis Center, and Breaks, Fractures, and Dislocations Center. Also, see eMedicine's patient education articles Carpal Tunnel Syndrome and Wrist Injury.
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