Have you ever been working a shift at 3 AM and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This is a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify common and catastrophic injuries. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. Last post, we reviewed the elbow. Now, the “Can’t Miss” adult wrist injuries.
- 25% of all sports related injuries involve the hand or wrist .
- Approximately 1.5% of all emergency department visits involve the hand and forearm .
- Missed wrist injuries can be highly morbid if injuries are missed.
- Missed wrist injuries are a common area of litigation.
- Avery, DM et al. Sports-related wrist and hand injuries: a review. Journal of Orthopaedic Surgery and Research, Vol 11, No 99, September 2016. https://www.ncbi.nlm.nih.gov/pubmed/27633260
- Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. The Journal of Hand Surgery Am, Vol 26, No 5, September 2001. https://www.ncbi.nlm.nih.gov/pubmed/11561245
- Forman TA. Forman SK, Rose NE. A Clinical Approach to Diagnosing Wrist Pain. American Family Physician, Vol 72, No 9, November 2005. https://www.ncbi.nlm.nih.gov/pubmed/16300037
- Stevenson M, Levis JT. Image Diagnosis: Scapholunate Dissociation. Perm J, Vol 23, March 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443367/
- Ramponi D. McSwigan T. Scapholunate Dissociation. Advanced Emergency Nursing Journal, Vol 38, No 1, January-March 2016. https://www.ncbi.nlm.nih.gov/pubmed/26817426
- Escarsa, R. et al. Chapter 269. Wrist Injuries. In: Tintinalli’s Emergency Medicine. A Comprehensive Guide, 7th edition. New York: McGraw-Hill Education, 2011. P1821-1830
- Muppavarapu et al. Perilunate Dislocations and Fracture Dislocations. Hand Clin, Vol 31, No 3, August 2015. https://www.ncbi.nlm.nih.gov/pubmed/26205701
- Cecava et al. Subtle radiographic signs of hamate body fracture: a diagnosis not to miss in the emergency department. Emerg Radiol, Vol 24, No 6. December 2017. https://www.ncbi.nlm.nih.gov/pubmed/28616787
- Takami et al. Isolated palmar dislocation of the distal radioulnar joint in a football player. Arch Orthop Trauma Surg, Vol 120, No 10 October 2000. https://www.ncbi.nlm.nih.gov/pubmed/11110145
- Bouri et al. Locked volar distal radioulnar joint dislocation. International journal of surgery case reports, Vol 22, March 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4844664/
- Pundkare et al. Carpometacarpal Joint Fracture Dislocation of second to fifth finger. Clinics in Orthopedic Surgery, Vol 7, No 4, December 2015. https://www.ncbi.nlm.nih.gov/pubmed/26640624
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