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Acute Wrist Trauma

'Sprained wrist does not exist' is a diagnosis only made in retrospect, after two sets of x-rays a fortnight apart (& a bone scan if still symptomatic).

Always examine carefully for carpal instability & look for occult fractures.


CARPAL INJURIES (bony avulsions of ligaments)

Progressive ligamentous disruption due to forced hyperextension.
Scapolunate, then Capitolunate then Triquetrolunate then dorsal radiocarpal ligament failure.

Arcs of the Wrist (A) & progression of carpal injury (B)Lesser Arc (ligament only)
Perilunar dislocation
Lunate dislocation

Greater Arc (through bone)
Trans-scaphoid perilunar dislocation (DeQuervain's injury) Rare
Trans-capitate perilunar dislocation


Lesser arc injuries
Perilunar dislocation (carpus dislocated dorsally off Lunate)
Lunate dislocation (lunate dislocated and angulated volar) may be two stages of the same process.
The displaced lunate does not always cause compression of the median nerve or lead to AVN of the lunate (a flap of capsule remains attached)

ExaminationPrograssion of Lesser Arc Injury
Bruising and tenderness over ligaments.
Chronic Watson's catch-up clunk of rotatory instability of scaphoid.



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Specific Nerve Injuries & Tendon Transfers
Acute Wrist Trauma
Advances in Distal Radius Fracture ...
Algorithm for distal Radius fractur...
Anatomy & Pathophysiology
Aphert Syndrome
Carpometacarpal arthritis of the th...
Chronic Wrist Pain
Colle's Type Fracture Manipulation
Compressive Neuropathies
Congenital Hand Disorders
CRPS
Distal Radius Fractures
Dupuytren’s - Related Research
Dupuytren's Disease
Hand - Tendon Transfers
Hand Fractures
Hand Infections
Hand Syllabus for FRCS (Tr & Orth)
Hand Trauma & Compartment Syndrome
Hand Tumours
Indications for Reduction in Distal...
Inflammatory Arthritis
Jules Tinel
Kienbock's Disease
Nerve Injuries - Principles
Replantation & Microsurgery
Scaphoid Fractures
Scapholunate Ligament Rupture
Tendon Injuries
Tendon Transfer - Principles
Ulnar Nerve Palsy Signs
Vascular Disorders
Wrist Arthroscopy
Wrist Instability
Wrist Osteoarthritis
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