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Orthopaedics
Wrist and Hand
Built from Orthopedic Trauma Essentials
What’s inside
5 sections · 109 slides
Overview
- What this topic is about
- Joints of the hand and wrist on X-ray
- Reading that X-ray
- Cut-through view of the wrist joint
- Two structures worth naming now
- The three injury families
- Words you will meet
- More words you will meet
Distal Radius Fractures
Instability, reduction targets, and who actually needs an operation
- A broken distal radius on two views
- Why instability is the key idea
- How instability used to be defined
- The AAOS post-reduction criteria
- The 2025 guideline is blunter
- What actually predicts instability
- A prediction model rather than a rule
- What the post-reduction picture adds
- Instability builds up over time
- A continuum, not a yes-or-no
- Straighter bone, better hand?
- Instability: what to take away
- Perfect bone or good enough bone?
- Two ways to judge a reduction
- Functional reduction: the verdict
- Should older patients be operated on?
- What the trials found in older adults
- Adding up the reviews
- Older patients: the bottom line
- When surgery is not optional
- The three ways to hold it
- Plate versus wires: the DRAFFT-2 trial
- Wires holding a distal radius fracture
- A plate on the palm side of the radius
- Where external fixation sits
- Choosing a fixation method
- When the bone is shattered
- The dorsal spanning plate
- Frame or spanning plate?
- Complex fractures: the verdict
- Does looking inside the joint help?
- What arthroscopy actually delivers
- The ulnar side of the wrist
- What the ulnar-side evidence shows
- Treating the ulnar side
- Three questions after the fracture is fixed
- Carpal tunnel release: not routinely
- Move it early, under supervision
- The fracture as a warning shot
- Adjuncts: the principle
- Distal radius fractures in one screen
Perilunate Injuries
Rare, easy to miss, and unforgiving of delay
- What a perilunate injury is
- How they happen
- Carpus displaced off the lunate, seen from the side
- The same injury viewed from the front
- Missed at the front door
- The old argument about timing
- What the follow-up studies show
- Why delay costs so much
- Timing: the recommendation
- Is putting the bones back enough?
- What ligament studies show
- The two ligaments that matter most
- The case against repairing everything
- Ligament repair: where practice has landed
- The nerve in a dislocated wrist
- Carpal tunnel release in perilunate injury
- Front door or back door?
- Which approach wins?
- Keyhole surgery for perilunate injuries
- Why open surgery is still standard
- Perilunate injuries in one screen
Scaphoid and Metacarpal Fractures
The carpal bone that hides its fracture, and the palm bones that forgive deformity
- Why the scaphoid gets special attention
- A thin dark line across the scaphoid
- The diagnostic problem
- What MRI gives you
- What CT gives you
- Which scan, when
- Imaging: the verdict
- Waist fractures: operate or plaster?
- What the randomized trials found
- What each option costs the patient
- Waist fractures: the verdict
- Why the proximal pole is different
- Proximal pole: what the studies say
- How far up the arm should the cast go?
- A below-elbow plaster cast from four sides
- Does the thumb need to be in the cast?
- Casting: the two rules
- Screw or wire, when you do operate?
- What wires cost you
- Metacarpal fractures: the forgiving ones
- A break at the neck of the little-finger metacarpal
- Why most of them do not need surgery
- Rotation is the line you cannot cross
- Four ways to fix a metacarpal
- The same fracture held by a wire down the bone
- What each implant trades away
- Metacarpal fixation: the verdict
- Scaphoid and metacarpal in one screen
Pulling It Together
The habits of thought this topic keeps rewarding
- Four themes that repeat
- Numbers worth remembering
- Decisions worth remembering
- Where the evidence is still thin
- References
- References (continued)
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- Orthopedic Trauma Essentials 2026