The most common displacement of the fracture is upward as seen in the image above and below. X-ray will confirm the direction of the injury. At times, enhanced imaging including CT scans or MRI is a helpful adjuvant. Typically routine x-rays are sufficient, although they may be taken from many angles. X-rays help delineate the type of fracture, displacement and if the fracture extends within a joint. X-rays of the wrist are obtained and if there is suspicion of injury to the hand, elbow or shoulder these may be obtained as well. Any deformity of the hand or wrist is also noted. Swelling from the fracture may cause compression of vascular structures leading to changes in blood supply to the hand. The most common nerve injured is the median nerve, resulting in numbness in the radial three digits of the hand. Sometimes patients with wrist fractures may have injured the nerves associated with the hand. Although unlikely, injuries to the adjacent shoulder and elbow are determined via checking for pain and motion.Īn examination of the sensation to the hand is performed. A physical exam centers on the injured limb. Inhibition of finger and wrist motion are also common.Ī fall causing a fracture of the distal radius-wrist fracture Hand Surgeon ExaminationĪfter taking note of the symptoms, the surgeon inquiries regarding any pertinent family or medical history. Patients tyically report pain, swelling, deformity, and bruising of the wrist. Image of a left wrist palm down showing the articulation of the radius with both the 8 wrist bones and the ulna Diagnosis SymptomsĪlmost all distal radius fractures occur as a course of trauma-the vast majority are due to falls on an ourstretched arm. Second, it articulates with the unlna to allow the hand to be turned palm up and palm down (pronation and supination). First, it articulates with the wrist to allow the wrist to bend and extend. The forearm is composed of the ulna and radius. The forearm connects the elbow to the wrist, allowing the hand to be placed into a functional position. The radius is the third most common bone to be broken in the human body. Patients who fall often fracture the radius. The forearm is composed of two bones, the radius and the ulna. Key secondary outcomes Functional outcomes: DASH score, return to work, activities of daily living (ADL), wrist pain, range of motion (ROM) and grip strength Condition or diseaseĭevice: Cylindrical cast Device: Modified sugar tong cast Device: Volar dorsal splintA Patient’s Guide to Distal Radius Fractures (Broken Wrist) with Animated Surgical Video Introduction Masking Single Blind Control Active Assignment Parallel Endpoints Efficacy Primary outcome Radiologic slippage of fracture at 4 weeks post reduction Study Phase Phase 3 Study Type Interventional - Assigned to treatment Recruitment status Completed 2003 Record Verification Date March 2003 Anticipated trial start date November 1998 Last Follow-Up Date December 2002 Data Entry Closure Date January 2004 Study Completion Date July 2004 Purpose Treatment Allocation Randomized Secondary outcomes were DASH score, return to work, activities of daily living (ADL), wrist pain, range of motion (ROM) and grip strength. Outcome Measurements: Loss of reduction (radiological slippage or the need for surgical fixation during the 3-4 week primary immobilization period after initial successful reduction). Secondary to assess long term functional outcomes associated with fiberglass splint immobilization versus standard cylindrical casting in patients maintaining initial non-operative reductions.ĭesign: Randomized prospective single blind controlled trial Patients/Participants: Patients over 18 years of age who presented to the emergency department with a displaced fracture of the distal radius, requiring closed reduction. Primary: To determine the effectiveness of three immobilization methods (circumferential cast, volar dorsal splint, modified sugar-tong splint) in maintaining the position of displaced distal radius fractures after successful closed reduction. We hypothesize that there will not be a clinically important difference between these methods of immobilizing for displaced fractures of the distal radius requiring closed reduction.Įxtended description of the protocol, including information not already contained in other fields. Maintenance of position was assessed at 4 weeks after the injury and wrist strength and function were assessed at 2 months and 6 months. The purpose of the study is to determine if there is any difference between 3 methods of immobilization for these fractures: circumferential cast, volar-dorsal splint, and modified sugar tong splint.
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