We’ve done shoulders. We’ve done ankles. We’ve done knees. We’ve done elbows. We’ve done hands. The only major orthopedic extremity injuries topic we haven’t covered on EM Cases are wrists (and hips). But hips are relatively straight forward. So, in this 2-part episode series we’re going to cover wrists and carpal bones. You might be thinking that wrist injuries are also pretty straight forward. But there are many nuances in diagnosis and management that significantly effect outcomes. In this episode Dr. Arun Sayal and Dr. Matt Distefano answer such questions as: when should we suspect a DRUJ injury, why is it important to pick up DRUJ injuries in the ED, and how does it change our management? Why is the lateral x-ray view so important in picking up commonly missed wrist injuries? When it comes to distal radius fractures, how are Colles vs Barton's vs Smith's fractures managed differently in the ED? What are the 2 key x-ray signs we should look for on the AP and the 2 key x-ray signs we should look for on the lateral for every wrist injury? What is a triangular fibrocartilage (TFC) injury and why is it important to pick up in the ED? and many more...



Podcast production, sound design & editing by Anton Helman; voice editing by Braedon Paul

Written Summary and blog post by Anton Helman December, 2023

Cite this podcast as: Helman, A. Sayal, A. Distefano, M. Commonly Missed and Mismanaged Wrist Injuries. Emergency Medicine Cases. December, 2023. https://emergencymedicinecases.com/wrist-injuries. Accessed July 3, 2024

Résumés EM Cases 

Go to part 2 of this 2-part podcast on wrist and carpal bone injuries

General principles in assessing wrist injuries



* Consider age-related prevalence when constructing an orthopedic differential diagnosis. Pediatric patients and older adults have weaker long bones than young adults; they are more likely to sustain a distal radius fracture after a FOOSH than a carpal bone injury. Carpal bone injuries occur almost exclusively in young adults.

* Knowing the surface anatomy of the wrist bones is essential to accurately diagnose commonly missed wrist injuries

* Volar injuries (eg Smith's, volar Barton's) occur with a force to the back of the hand, are generally more unstable compared to dorsal injuries (eg Colles) requiring more urgent orthopedics involvement for consideration of surgery as well as above elbow splint

* DRUJ has been called the "forgotten joint of the wrist" and requires careful consideration in all wrist injuries, an awareness of the pronation/supination mechanism of injury, specific physical exam maneuvers and immobilization with an above elbow splint



Wrist physical examination for commonly missed and mismanaged wrist injuries: Know the surface anatomy

It is important to complete a thorough wrist exam before ordering/interpreting the x-ray to help narrow your differential diagnosis and guide the x-ray request.

Active range of motion (ROM) followed by ROM against resistance should precede palpation.