Edited by Grace Xiong, Harry Lightsey, and Brendan Striano - 7/1/2021
Descriptors
Dorsally displaced (Colles'), volarly displaced (Smith's), fracture dislocation of RCJ/intraarticular (Barton's)
Exam Pearls
Upper extremity neurovascular exam
Acute Carpal Tunnel Syndrome (ACTS): acute to subacute onset paresthesias and severe pain in the median n. distribution
Examine volar and ulnar wrist for poke-hole open injuries
Specifically evaluate EPL function (risk for EPL tendon injury) - thumb retropulsion
Workup
Radiographs: AP/Lat/Obl XRs of Wrist, add forearm if proximal pain to rule out Galeazzi
Other imaging: Post-reduction CT if suspect inta-articular comminution to assess intraarticular involvement
Labs: None, unless admitting
Other: None
Management
Need for acute intervention:
Displaced: immobilization with reduction
Nondisplaced: immobilization without reduction
Weight-bearing and range of motion: NWB UE, ROMAT elbow, MCP and distal
Type of immobilization: Closed reduction and Volar Dorsal Slab following Hematoma Block
Admission or discharge status: Discharge w/ 1 wk f/u for alignment check and discussion regarding surgery v. non-op management
Anticoagulation: None
Antibiotics: None
Surgical Indications
Absolute: Open fracture, acute carpal tunnel syndrome (urgent OR), >2mm intra-articular displacement (nonurgent OR)
Relative: Age, handedness, employment considerations for minimally displaced (<2mm) intraarticular fractures, likelihood to redisplace Wristcalc