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Introduction: Amateur and professional participation in sport and physical activity worldwide is increasing in popularity, which in turn is increasing the volume and types of injuries sustained by athletes. Ensuring these injuries are treated appropriately and efficiently is paramount for athletes' recovery and return to sport in a timely and safe manner., Methods: A scoping review to map the evidence regarding the treatment, outcomes and management of hand, wrist, finger, and thumb injuries in the professional/amateur athlete from contact sports. A search of seven electronic databases; SPORTdiscus, CINAHL, Medline, Scopus, Web of Science, Embase and Cochrane Library and grey literature was conducted in January 2024. The reporting of the review is in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. Inductive content analysis was used to examine the data and the Critical Appraisal Skills Programme was used to appraise the quality of the included studies., Results: Eight papers met the inclusion criteria and three themes emerged addressing the return to play/sport, surgical and conservative treatment and the most common/reoccurring injuries sustained from contact sports., Conclusion: Managing hand, wrist, finger, and thumb injuries in athletes requires a varied approach depending on the type of injury, treatment options, and external pressures. While conservative treatment is common and effective, surgical intervention may be necessary in certain cases to improve recovery and facilitate a faster return to sport. Preventive measures in high-risk sports settings could help reduce the incidence of these injuries., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Caring for hand and wrist injuries in the elite athlete brings distinct challenges, with case-by-case decisions regarding surgical intervention and return-to-play. Metacarpal fractures, thumb ulnar collateral ligament tears, and scaphoid fractures are common upper-extremity injuries in the elite athlete that can be detrimental to playing time and future participation. Treatment should therefore endure the demand of accelerated rehabilitation and return-to-activity without compromising long-term outcomes. Fortunately, the literature has supported emerging management options that support goals specific to the athlete. This review examined the advances in surgical and perioperative treatment of metacarpal fractures, thumb ulnar collateral ligament injuries, and scaphoid fractures in the elite athlete., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to evaluate changes in both mechanism and diagnoses of injuries presenting to the orthopaedic department during this lockdown period, as well as to observe any changes in operative case-mix during this time., Methods: A study period of twelve weeks following the introduction of the nationwide "lockdown period", March 23 rd - June 14 th , 2020 was identified and compared to the same time period in 2019 as a "baseline period". A retrospective analysis of all emergency orthopaedic referrals and surgical procedures performed during these time frames was undertaken. All data was collected and screened using the 'eTrauma' management platform (Open Medical, UK). The study included data from a five NHS Foundation Trusts within North West London. A total of 6695 referrals were included for analysis., Results: The total number of referrals received during the lockdown period fell by 35.3% (n=2631) compared to the same period in 2019 (n=4064). Falls remained proportionally the most common mechanism of injury across all age groups in both time periods. The proportion sports related injuries compared to the overall number of injuries fell significantly during the lockdown period (p<0.001), however, the proportion of pushbike related accidents increased significantly (p<0.001). The total number of operations performed during the lockdown period fell by 38.8% (n=1046) during lockdown (n=1732). The proportion of patients undergoing operative intervention for Neck of Femur (NOF) and ankle fractures remained similar during both study periods. A more non-operative approach was seen in the management of wrist fractures, with 41.4% of injuries undergoing an operation during the lockdown period compared to 58.6% at baseline (p<0.001)., Conclusion: In conclusion, the nationwide lockdown has led to a decrease in emergency orthopaedic referrals and procedure numbers. There has been a change in mechanism of injuries, with fewer sporting injuries, conversely, there has been an increase in the number of pushbike or scooter related injuries during the lockdown period. NOF fractures remained at similar levels to the previous year. There was a change in strategy for managing distal radius fractures with more fractures being treated non-operatively., (Copyright © 2021. Published by Elsevier Ltd.)

During the protective phase of treatment, therapy for hand and wrist injuries in athletes is similar to the plan of care provided to all patients. The nuances in the care provided to athletes become apparent during the transition to the postprotective phase of rehabilitation when the focus has shifted to return to play. Therapy following a sports injury should address the individual needs of the athletes in their everyday lives as well as the specificity of their training and sports-specific activities. The factors that influence return to play are discussed., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2019 Elsevier Inc. All rights reserved.)

This article examines the most common problematic hand and wrist injuries in the pediatric athlete. Hand and wrist injuries in the growing skeleton pose a different diagnostic and therapeutic challenge than in the mature skeleton. Ligaments are stronger than bone, and unossified cartilaginous sections of the skeleton are yet more susceptible to injury than bone. Although remodeling can correct for even moderate deformities if sufficient growth potential exists, remodeling cannot return the child to normal anatomy in many cases. Remodeling depends on intact periosteum, a nearby growing physis, and competent ligaments to direct remodeling via Hueter-Volkmann and Wolff's laws., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Tendinopathies in the hand and wrist are common in athletes. This article reviews some of the common hand and wrist conditions, such as trigger digits, first dorsal compartment tendonitis, and extensor carpi ulnaris tendonitis. In addition, it reviews less commonly seen tendon conditions of the flexor carpi radialis and ulnaris, intersection syndrome, and extensor pollicis entrapment conditions. Diagnosis, nonoperative and operative treatment, and postoperative recommendations and return to play are also discussed., Competing Interests: Disclosure There are no financial conflicts of interest to disclose., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Ulnar-sided wrist pain is a common problem in athletes that can be challenging owing to its frequent combination of overuse in conjunction with acute injury. Repetitive pronosupination, wrist flexion and extension, as well as radial and ulnar deviation can predispose the athlete to injury of ulnar structures. Careful understanding of the sport-specific injuries as well as the underlying biomechanics are key to understanding and treating the athlete. In this article, we discuss the most frequent causes of ulnar-sided wrist pain in the athlete and focus on anatomy and pathophysiology, presentation, and diagnosis, as well as nonoperative and operative treatment options., Competing Interests: Conflict of Interest Each author certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article. No funding or financial support was received for this project., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Intersection syndrome is an inflammatory condition located at the crossing point between the first and second dorsal compartments in the wrist. It is an uncommon presentation but has been recognized as an injury typical of rowers (when it is named oarsman's wrist) and other sports such as racquet sports, baseball, cycling, hockey, golf, ice hockey, skiing, and softball. It has not been previously described in climbers. This report details 2 cases of intersection associated with the use of an ice axe. The first presentation was in a female climber who was using an ice axe for climbing in the Nepal Himalayas and the second was in a male climber using an ice axe for winter climbing training in the Alps. Both climbers presented with wrist pain, swelling, and crepitus over the dorsum of the wrist, about 5 cm proximal to Lister's tubercle. Although well documented in other sporting populations, there seems to be limited reporting of intersection syndrome in the climbing population. It may be worth considering a diagnosis of "ice axe wrist" as a differential in patients who have been using ice axes in climbing or mountaineering., (Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Background: Injuries sustained to the hand and wrist are common, accounting for 20% of all emergency presentations. The economic burden of these injuries, comprised of direct (medical expenses incurred), indirect (value of lost productivity) and intangible costs, can be extensive and rise sharply with the increase of severity., Objective: This paper systematically reviews cost-of-illness studies and health economic evaluations of acute hand and wrist injuries with a particular focus on direct, indirect and intangible costs. It aims to provide economic cost estimates of burden and discuss the cost components used in international literature., Materials and Methods: A search of cost-of-illness studies and health economic evaluations of acute hand and wrist injuries in various databases was conducted. Data extracted for each included study were: design, population, intervention, and estimates and measurement methodologies of direct, indirect and intangible costs. Reported costs were converted into US-dollars using historical exchange rates and then adjusted into 2015 US-dollars using an inflation calculator RESULTS: The search yielded 764 studies, of which 21 met the inclusion criteria. Twelve studies were cost-of-illness studies, and seven were health economic evaluations. The methodology used to derive direct, indirect and intangible costs differed markedly across all studies. Indirect costs represented a large portion of total cost in both cost-of-illness studies [64.5% (IQR 50.75-88.25)] and health economic evaluations [68% (IQR 49.25-73.5)]. The median total cost per case of all injury types was US$6951 (IQR $3357-$22,274) for cost-of-illness studies and US$8297 (IQR $3858-$33,939) for health economic evaluations. Few studies reported intangible cost data associated with acute hand and wrist injuries., Conclusions: Several studies have attempted to estimate the direct, indirect and intangible costs associated with acute hand and wrist injuries in various countries using heterogeneous methodologies. Estimates of the economic costs of different acute hand and wrist injuries varied greatly depending on the study methodology, however, by any standards, these injuries should be considered a substantial burden on the individual and society. Further research using standardised methodologies could provide guidance to relevant policy makers on how to best distribute limited resources by identifying the major disorders and exposures resulting in the largest burden., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Wrist and hand injuries are common among athletes, and can lead to considerable disability. Dislocations and soft tissue injuries are common and require prompt recognition and treatment. Accurate diagnosis and early immobilization are often key to getting players back to their sport early. Some injuries require surgery; operative intervention allows the player to return to their sport more quickly or with less long-term disability. This article discusses the spectrum of injury from distal radius fractures to mallet fingers, and offers some general guidelines for the surgeon in how to counsel and treat athletes with these problems., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Hand and wrist injuries are very common at the Emergency Departments (ED), and among the most costly injury types in the working population. The purpose of this study was to explore the causes of non-trivial hand and wrist injuries (i.e., hand fractures, wrist fractures and complex soft-tissue injuries) in working-age adults in order to identify target areas for prevention., Methods: Data were extracted from the Dutch Injury Surveillance System, from the National Hospital Discharge Registry and from a patient follow-up survey in working-age adults (aged 20-64 years) in the period 2008-2012. An incidence-based cost model was used to estimate healthcare costs, and an absenteeism model for estimating the productivity costs. Total costs were calculated by external cause, subdivided in their main categories (home, sports, work, traffic and violence) and their most important subclasses., Results: Total costs of these injuries in The Netherlands were US $410 million per year, of which 75% (US $307 million) productivity costs. Males represented 66% (US $271 million) of the total costs. Within the male group, the group 35-49 years had the highest contribution to total costs (US $112 million), as well as the highest costs per case (US $10,675). Work-related injuries showed the highest costs per case (US $11,797), however, only 25% of the total costs were work-related. The top five causes in terms of total costs were: accidents at home (falls 23%, contact with an object 17%), traffic (cycling 9%) and work (industrial work 4%, and construction work 4%)., Conclusion: Hand and wrist injuries are a major cause of healthcare and productivity costs in working-age adults. To reduce the costs to society, prevention initiatives should be targeted at major contributing causes, that are mainly related to activities at home (falls, contact with an object) and accidents at the road (cycling)., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Purpose: To evaluate clinical and radiological outcomes after conservative treatment and arthroscopic-assisted screw fixation of acute non- or minimally displaced scaphoid waist fractures in a randomized controlled trial., Methods: Consecutive patients with acute non- or minimally displaced scaphoid waist fractures were prospectively randomized to conservative or surgical treatment. All patients were screened using radiographs, computed tomography, and magnetic resonance imaging. Conservative treatment consisted of a below-elbow thumb spica cast until radiological signs of union appeared. Surgical treatment consisted of wrist arthroscopy and percutaneous antegrade screw fixation. Clinical examination, radiographs, and computed tomography were used to follow the patients. Twenty-four patients were treated conservatively and 14 patients underwent surgery. The patients were followed at regular intervals for 1 year after surgery. Twenty-one patients treated conservatively and 14 treated surgically were available for follow-up after a median of 6 years (range, 4-8 y)., Results: At 26 weeks, the conservatively treated group had significantly better range of motion and had reached almost normal value compared with the contralateral wrist. There were no significant differences between the 2 groups concerning grip or pinch strengths at any measure point. At follow-up after a median of 6 years, radiographic signs of arthritis in the radioscaphoid joint were more common in the surgically treated group (3 of 14) than in the conservative group (2 of 21)., Conclusions: Non- and minimally displaced scaphoid waist fractures are best treated conservatively. Operative treatment may provide an improved functional outcome in the short term but at the price of a possible increased risk of arthritis in the long term., Type of Study/level of Evidence: Therapeutic II., (Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Two patients presented with radial-sided wrist pain and longitudinal split tears of the extensor pollicis brevis tendon. Surgical debridement and repair was performed on the first patient with good results. Early diagnosis in the second patient led to successful treatment with immobilization alone. If diagnostic maneuvers for de Quervain tenosynovitis produce pain in a location other than the radial styloid, advanced imaging should be considered to identify other anatomic causes for the pain., (Published by Elsevier Inc.)

Therapists treating athletes with hand and wrist injuries may be involved in all stages of recovery, from the acute phase to return to sport. This article gives case examples of how creative use of custom and commercially available orthoses, splints, tape, and braces can augment various stages of recovery. Understanding the specific demands of the sport and respect for the standards of care are imperative to fabricating or fitting an athlete with the best device or customization of the athlete's own equipment for a safe return to sport., (Copyright © 2015 Elsevier Inc. All rights reserved.)

This article provides a philosophic overview of the management of athletes at all levels from high school to professional. It further reviews sports-specific injury patterns and position-specific injury patterns. This aspect is crucial, as many injuries may be relatively common for specific sports but rare in the general population, so recognition of these injuries requires a high degree of suspicion. The guiding principles of management are also discussed., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Participation in gymnastics and other upper extremity weight-bearing sports frequently requires athletes to bear significant loads through their wrists. This requirement makes wrist pain and injury of significant concern to competitive gymnasts. Athletes' wrist pain, and their ultimate evaluation and treatment, are subject to many variables. Diagnosing the cause of wrist pain in a gymnast requires understanding of the interplay between sport-specific mechanics imparted to the wrist and the individual athlete's characteristics. Treatment entails the appropriate use of conservative measures or surgical intervention with an emphasis on collaborating with all members of the patient's treatment and training team., (Copyright © 2015 Elsevier Inc. All rights reserved.)

The athlete's wrist, especially those using bats, sticks, racquets, or clubs, is subjected to extremely high torque loads during athletic activities. These loads stress the stabilizing elements of the ulnocarpal and distal radioulnar complexes. Lesions of these regions can lead to painful dysfunction and instabilities that negatively impact athletic performance. This article reviews some of the common ulnar-sided maladies focusing on anatomy, biomechanics, diagnosis, and treatment., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Positional faults are considered a possible underlying mechanism mimicking the symptoms of a joint sprain. Despite numerous clinical studies indicating the presence of positional faults, there is limited evidence of imaging studies confirming positional faults. This case report is a preliminary study that offers clinical and ultrasonographic evidence of a proximal positional fault of the radius, treated successfully with manual therapy techniques. Three weeks after a bike fall on the outstretched hand, the patient in this study presented with right wrist pain and a lack of progress with conventional conservative treatment (NSAIDs, rest and immobilization). Clinical findings indicating a proximal positional fault of the radius included pain during active pronation increased by associating a passive movement of the radius in a proximal direction and it was reduced by associating a passive movement of the radius in a distal direction. Ultrasonographic (US) images showed a reduction of radio-capitellar distance on the right side (11.4 mm) compared to the left side (13.3 mm). A positive response with a distal mobilization of the radius supported the proximal positional fault of the radius. After two manual therapy sessions, the patient had recovered normal asymptomatic function. The outcomes used to assess function and pain were active pronation range of motion, the Spanish version of the DASH questionnaire and a 0-10 numeric pain rating scale. Each measure was conducted prior and after each treatment session and one week post treatment. The patient was re-examined at 6 months follow-up, during which US images, demonstrated a normalization of the right radio-capitellar distance., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Purpose: Grip strength is influenced primarily by body mass index, sex, and age. It is also partly voluntary and correlates with symptoms of depression. This study examined whether psychological factors influence grip more in the setting of injury than in healthy volunteers., Methods: Grip strength was evaluated in one hundred subjects, 50 healthy individuals and 50 patients 6 weeks after a nonsurgically treated fracture of the distal radius. Grip strength was measured as the mean of 3 attempts, and patients completed questionnaires for arm-specific disability (Disabilities of the Arm, Shoulder, and Hand), depression, pain anxiety, catastrophic thinking, and negative thoughts in response to pain., Results: The mean grip strength in the injured group was 55% of the uninjured side. Pain anxiety accounted for 9% of the variability in grip strength in injured wrists. Among healthy patients, sex was the only correlate of dominant-side grip strength, and body mass index accounted for 8% of the variation in the grip strength of the nondominant side divided by the dominant side., Conclusions: The majority of the variation in grip strength remains unaccounted for, but physical factors correlate best with grip strength and percent grip strength of the nondominant side divided by the dominant side in healthy patients, and psychological factors correlate best with absolute grip in patients recovering from distal radius fractures., Clinical Relevance: The influences on grip strength are complex, but the differences among recovering and healthy patients demonstrate a role for nonphysical factors in grip strength during recovery., (Copyright © 2012. Published by Elsevier Inc.)

Objective: The results of two randomized clinical trials (RCTs) demonstrate the clinical effectiveness of alternatives to casting for certain ankle and wrist fractures. We illustrate the use of value of information (VOI) methods for evaluating the evidence provided by these studies with respect to decision making., Study Design and Setting: Using cost-effectiveness data from these studies, the expected value of sample information (EVSI) of a future RCT can be determined. If the EVSI exceeds the cost of the future trial for any sample size, then the current evidence is considered insufficient for decision making and a future trial is considered worthwhile. If, on the other hand, there is no sample size for which the EVSI exceeds the cost, then the evidence is considered sufficient, and no future trial is required., Results: We found that the evidence from the ankle study was insufficient to support the adoption of the removable device and determined the optimal sample size for a future trial. Conversely, the evidence from the wrist study was sufficient to support the adoption of the removable device., Conclusions: VOI methods provide a decision-analytic alternative to the standard hypothesis testing approach for assessing the evidence provided by cost-effectiveness studies and for determining sample sizes for RCTs., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Ulnar-sided wrist pain is a common cause of upper extremity disability. Presentation can vary from acute traumatic injuries to chronic degenerative conditions. Because of its overlapping anatomy, complex differential diagnosis, and varied treatment outcomes, the ulnar side of the wrist has been referred to as the "black box" of the wrist, and its pathology has been compared with low back pain. Common causes of ulnar-sided wrist pain include triangular fibrocartilaginous complex injuries, lunotriquetrial ligament injuries, and ulnar impaction syndrome., (Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Purpose: As the population in developed countries continues to age, the incidence of osteoporotic distal radius fractures (DRFs) will increase as well. Treatment of DRF in the elderly population is controversial. We systematically reviewed the existing literature for the management of DRFs in patients aged 60 and over with 5 common techniques: the volar locking plate system, nonbridging external fixation, bridging external fixation, percutaneous Kirschner wire fixation, and cast immobilization (CI)., Methods: We reviewed articles retrieved from MEDLINE, Embase, and CINAHL Plus that met predetermined inclusion and exclusion criteria in 2 literature reviews. Outcomes of interest included wrist arc of motion, grip strength, functional outcome measurements, radiographic parameters, and the number and type of complications. We statistically analyzed the data using weighted means and proportions based on the sample size in each study., Results: We identified 2,039 papers and selected 21 papers fitting the inclusion criteria in the primary review of articles with a mean patient age of 60 and older. Statistically significant differences were detected for wrist arc of motion, grip strength, and Disabilities of the Arm, Shoulder, and Hand score, although these findings may not be clinically meaningful. Volar tilt and ulnar variance revealed significant differences among groups, with CI resulting in the worst radiographic outcomes. The complications were significantly different, with CI having the lowest rate of complications, whereas the volar locking plate system had significantly more major complications requiring additional surgical intervention., Conclusions: This systematic review suggests that despite worse radiographic outcomes associated with CI, functional outcomes were no different from those of surgically treated groups for patients age 60 and over. Prospective comparative outcomes studies are necessary to evaluate the rate of functional recovery, cost, and outcomes associated with these 5 treatment methods., (Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Introduction: Closed reduction (CR) to restore fracture alignment and subsequent cast fixation is a common practice in the treatment of distal radius fractures. No clear consensus exists about the appropriate indication for CR. This study aims to compare radiological and functional results in patients with moderately to severely displaced distal radius fractures that were immobilised by cast fixation with or without prior CR., Patients and Methods: A total of 206 patients with distal radius fractures from one UK hospital were prospectively documented between 2001 and 2002. Patients with moderately to severely displaced fractures that were treated conservatively with or without CR were eligible for this analysis. Fracture displacement was assessed by measurements on injury radiographs and latent class analysis. The radiological and functional results as assessed by range of motion; and the Disabilities of the Arm, Shoulder and Hand (DASH); Gartland and Werley; and SF-36 scores were compared after 6 weeks, 6 months and 1 year., Results: As many as 83 patients (seven males) with a mean age of 62.2 years were included; 62 patients were treated with CR, the remaining 21 did not receive CR. During the follow-up period, no differences were found in the measurements of range of motion, DASH and SF-36 scores between the treatment groups. Fractures that were treated with CR lost anatomical restoration. However, after 1 year, palmar tilt and radial angles had significantly improved compared with the baseline measurements. Although no significant difference of radiological parameters between the treatment groups was found, the Gartland and Werley score resulted in a significantly better outcome for those patients without CR after 1 year., Conclusions: Although all patients - independent of their treatment - reached a successful level of activities in their daily life, there was no benefit of CR for patients with moderately to severely displaced fractures. The decision to treat with CR should be made carefully, especially in patients with high wrist-function demands., (Copyright 2009 Elsevier Ltd. All rights reserved.)

The extensor mechanism of the fingers, hand, wrist, and forearm is extremely intricate. Disruptions to the extensor system are common and can be associated with poor patient outcomes when not treated appropriately. Although extensor tendon injuries receive much less attention in the literature than flexor tendon injuries do, several recent studies have examined this topic. This article presents an overview of the treatment of extensor tendon injuries, with a focus on recent developments., (Copyright 2010. Published by Elsevier Inc.)

Although ulnar neuropathy can occur at the wrist in association with distal radius fractures, few late-onset cases have been reported. The authors describe 2 cases of delayed-onset ulnar neuropathy at the wrist, which developed 12 and 30 years after sustaining a conservatively treated distal radius fracture. During late neurolysis, both patients were found to have a perforation in the volar wrist capsule and synovitis and arthritis in the distal radioulnar joint., (Copyright 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Three geometries of volar slab plaster cast for the stabilisation of wrist fractures were investigated. It was found that by moulding reinforcement ridges on the inferior surface of the slab the strength and stiffness could be doubled with only a 20% increase in weight. It was discovered that to provide the same increase in strength with a traditional cast the entire thickness of the cast would have to be doubled, with a 100% increase in weight that would be cumbersome to most users. Bending theory is presented in a simple manner to allow clinicians to understand how reinforcement mouldings can improve the strength and stiffness of plaster casts without adversely influencing weight, or cost.

Aim: To compare outcomes regarding splinting versus casting of paediatric torus fractures in the ED with the aim of establishing the preferred treatment., Methods: Evidence was collated using electronic databases; Pubmed, Ovid, Medline and Cochrane library. Search terms included [torus fractures; buckle fractures; splinting distal radius fractures; paediatric wrist fractures; paediatric forearm fractures/injuries; cast versus splint]. Searches identified papers published between 1984 and June 2008., Results: The review demonstrated that children with removable splints preferred them to casts, in terms of improved physical functioning and lower pain scores reported after initial injury than those with casts. Children demonstrated this by using their wrists in the first week after injury to shower and bathe more easily. The cast group reported unscheduled visits to ED due to problems with the cast, such as discomfort or re-application of the cast from getting it wet. Using a splint will have considerable economic implications, money was found to be saved in terms of time and resource management. Radiographs taken at 4 weeks in both the cast and splint group confirmed that all fractures healed without significant change in alignment, suggesting that neither clinical nor radiographic follow-up is necessary for injury., Conclusion: Torus splints in all the studies were consistently better than plaster immobilisation in terms of clinical outcome, patient preference and cost, with the exceptions of young children or children with special needs who can easily remove the device. Splinting torus fractures may reduce cost, time and resource management if used instead of casting in the ED.

Injuries to the thumb are predominated by fractures of the proximal phalanx, ligamentous injuries about the metacarpophalangeal joint, and metacarpal base fractures. This article will attempt to summarize recent advancements within the realm of thumb trauma, with particular attention to Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries.

Purpose: Our study assessed the radiographic outcomes of nonsurgically treated distal radius fractures of patients who were 18 to 44 years old (group 1), 45 to 64 years old (group 2), and 65 years old or older (group 3)., Methods: All distal radius fractures seen in our emergency department from April 2002 to September 2004 that had nonsurgical management (either casting alone or closed reduction with immobilization) were considered for this study (n = 124; 50 casted, 74 closed reduced). Patients were further classified by age. Change in fracture alignment was assessed at the time of fracture union (approximately 8 weeks) and included measurements of angulation, articular gap/step-off, and radial shortening., Results: When the fractures (n = 124) were evaluated at union, there was an overall secondary displacement rate of 64% (n = 79), with 42% in the group whose fractures were immobilized in a cast and 78% in the group whose fractures were treated by closed reduction and cast. There was an increase in displacement rate that was associated with increasing patient age. Among fractures that were only casted, there was no such age-matched increase in rates of secondary displacement. However, when considering those fractures that were subject to closed reduction (n = 74), rates of secondary displacement significantly increased with age (58% in group 1, 81% in group 2, and 89% in group 3; p = .03)., Conclusions: Our study found that secondary displacement of distal radius fractures increased with increasing patient age, primarily among fractures subject to closed reduction. Older patients with these fractures require closer management after initial reduction, therefore allowing for better monitoring of expected subsequent fracture collapse. Further, given these high rates of secondary displacement after nonoperative treatment (58% to 89%), it is also important to consider that surgical treatment of these fractures may be necessary.

In 1984, the Department of Health (DoH) recommended that all patients with deliberate self-harm (DSH) must have a mental assessment before discharge. DSH patients, especially those with lacerations to wrist and forearm, are a regular source of admission to plastic surgery units. In Northern Ireland, the regional plastic surgery service is provided at the Ulster Hospital, which does not have an on-site psychiatric department. Consequently, it was often difficult to arrange a psychiatrist assessment for these patients on the ward even when the assessment was required urgently. The objective of this study was to develop and validate a protocol that would ensure that these patients were assessed and followed up for their mental health as recommended by the DoH. In the absence of clear guidelines from the DoH and utilising the existing arrangement between Accident and Emergency (A&E) and the psychiatric services, all referring A&E departments were instructed at the time of referring patients with DSH to wrist and forearm to arrange a psychiatric examination before transferring the patient to the plastic surgery unit. Data were collected retrospectively (August 2002-October 2002) and prospectively (November 2002-October 2003) and comprised demographic features, previous history of self-harm, conduct of the patient in A&E and the ward, length of stay in the hospital and various aspects of psychiatric assessment and follow-up. In total, 42 referrals were made during the period studied. The average age was 28 years with a male to female ratio of 2:1. The average hospital stay was two days. Despite difficulties, our practice was found effective in ensuring psychiatry assessment and follow-up without risking the patient's physical health. The study also highlighted the need for collaboration between plastic surgeons and psychiatrists to improve services in regards to DSH patients.

Background: The purpose of this study was to evaluate the radiographic outcome of unstable distal radius fractures treated by closed reduction and sugar tong splinting and to quantitatively evaluate Lafontaines' criteria of instability., Methods: Fifty patients with 3 or more instability factors as described by Lafontaine were treated by finger trap traction, closed reduction, and sugar-tong splinting. They were evaluated radiographically for initial angulation, radial inclination, radial length, and palmar tilt at the time of injury, after reduction, and 1 week, 2 weeks, and 4 weeks after reduction. The fracture either maintained an adequate reduction or failed to maintain an adequate reduction and showed secondary displacement based on specific criteria., Results: At 4 weeks after reduction 46% of these unstable distal radius fractures maintained an adequate reduction. Of the 54% of fractures that failed to maintain an adequate reduction, age was the only statistically significant predictor of secondary displacement. After obtaining an acceptable initial closed reduction, patients 58 years of age were found to be at 50% risk for secondary displacement. The risk for displacement with an unacceptable radiographic result was found to increase with increasing age and decrease with decreasing age., Conclusion: In the closed management of these potentially unstable distal radius fractures, age was the only statistically significant risk factor in predicting secondary displacement and instability. These data help guide treatment by closed reduction and immobilization with serial x-rays or by surgical stabilization.

Purpose: There have been few prospective studies of elderly patients with conservatively treated distal radius fractures and little is known about the relationship between acceptable radiographic reduction and functional outcomes in this population. We hypothesized that acceptable fracture reduction (according to standard radiographic dorsal/volar tilt criteria) would be associated with better functional outcomes and greater satisfaction., Methods: Seventy-four patients who were at least 50 years of age with conservatively managed distal radius fractures were recruited from 2 large urban emergency departments from January 2001 to December 2001. Patients with wrist fractures treated in the emergency department and discharged home were included; patients admitted to the hospital or who required surgical reduction were excluded. Standard lateral radiographs were taken after the final cast was removed. These were reviewed independently by a reference-standard musculoskeletal radiologist and the degree of dorsal/volar tilt was recorded. This value was dichotomized according to standard published dorsal/volar tilt criteria as acceptable (dorsal tilt <10 degrees or volar tilt <20 degrees ) or unacceptable (dorsal tilt >10 degrees or volar tilt >20 degrees ). The Medical Outcomes Study Short-Form 12 (SF-12); the Disabilities of the Arm, Shoulder, and Hand questionnaire; and a patient satisfaction survey were used to assess patient-reported outcomes 6 months after the injury., Results: The average dorsal/volar tilt measured by the reference standard radiologist was 3.4 degrees (SD=13.6) dorsal; overall 47 patients (64%) were considered to have an acceptable radiographic reduction. Acceptable radiographic reduction was not associated with better generic physical or mental health status, lesser degrees of upper-extremity disability, or greater satisfaction with outcomes than was unacceptable reduction. Overall 44 of 74 patients (59%) reported being satisfied or very satisfied with their functional status at 6 months., Conclusions: Contrary to our hypotheses we found that acceptable radiographic reduction (according to dorsal/volar tilt criteria) was not associated with better self-reported functional outcomes or increased satisfaction at 6 months in elderly patients with conservatively treated distal radius fractures.

A series of 52 patients who had been treated nonsurgically for wrist pain after an inconclusive physical examination, normal standard radiographs, and a negative radiocarpal arthrogram result were surveyed using the Disabilities of the Arm, Shoulder, and Hand (DASH) and Short Form-12 (SF-12) instruments after a minimum of 2 years (average, 6.1 years). Forty-two patients (81%) responded to the survey. Average duration of symptoms before the initial evaluation was 13 months. At follow-up evaluation, mean SF-12 score was 50 (national mean, 50). Mean DASH score was 17 compared with 2 for a control group of 60 people. Sixty-four percent of patients reported improvement, 19% were unchanged, and 17% were worse since the initial evaluation. Two patients were receiving disability benefits. Duration of symptoms >12 months was associated with a worse outcome. These results show that patients with wrist pain but without a diagnosis by these evaluation methods often have persistent symptoms after nonsurgical treatment, but the symptoms are usually mild and improve.

Sports medicine practitioners must be sensitive to even the smallest injuries that affect athletes. Often, less severe ligament injuries go undetected. Scapholunate dissociation is often overlooked in this manner. The authors provide an overview of presentation, diagnosis, and nonoperative and operative treatments of this condition.

A 41-year-old man experienced severe pain in the forearm after undergoing ulnar shortening osteotomy to treat positive ulnar variance, a complication of a fracture of the distal end of the radius. The patient had compartment syndrome with compartment pressure of 55 mm Hg. A decompressive fasciotomy of the volar compartment provided total relief of pain and, subsequently, full recovery of all functions. We report the case and discuss the serious nature of compartment syndrome, its associated complications, and methods of diagnosis and management., (Copyright 2000 by the American Society for Surgery of the Hand.)

Background: The pathogenesis of reflex sympathetic dystrophy (RSD) is not clear, nor is there a definitive treatment for this syndrome. The morbidity, costs in health care, and loss of work time justify the search for a means to prevent post-traumatic dystrophy. Although the role of toxic oxygen radicals has not yet been clarified, we investigated vitamin C (ascorbic acid) as a prophylactic antioxidant drug., Methods: 123 adults with 127 conservatively treated wrist fractures were randomly allocated in a double-blind trial to take a capsule of 500 mg vitamin C or placebo daily for 50 days. Each participant's sex, age, side of fracture, dominance, fracture type, dislocation, reduction, and complaints with the plaster cast were recorded, and they were clinically scored for RSD. The follow-up lasted 1 year., Findings: Eight patients were withdrawn after randomisation. 52 patients with 54 fractures (male 22%, female 78%; mean age 57 years) received vitamin C and 63 patients with 65 fractures (male 20%, female 80%; mean age 60 years) received placebo. RSD occurred in four (7%) wrists in the vitamin C group and 14 (22%) in the placebo group 15% (95% CI for differences 2-26). Other significant prognostic variables for the occurrence of RSD were complaints while wearing the cast (relative risk 0.17 [0.07-0.41]) and fracture type (0.37 [0.16-0.89])., Interpretation: This prospective, double-blind study shows that vitamin C was associated with a lower risk of RSD after wrist fractures. Our hypothesis is that this beneficial effect of prophylaxis would be useful in other forms of trauma.

Intersection syndrome is a condition that should be differentiated from DeQuervain's stenosing tenosynovitis, as there are many subtle differences in treatment and prognosis. We present a case of intersection syndrome, describing its characteristic clinical and anatomic features, and highlighting differences in the areas of diagnosis and treatment relative to the better known DeQuervain's tenosynovitis.

We report a case of isolated volar dislocation of the distal radio-ulnar joint in a young man who injured his left wrist while playing rugby. Initially, this injury was missed in the emergency department; however, a true lateral view radiograph later revealed volar dislocation of the distal radio-ulnar joint. The dislocation was subsequently reduced under general anesthesia with a good end result. The importance of thorough clinical examination and a true lateral view radiograph of the wrist is stressed.

A case of pseudoaneurysm of the ulnar artery occurring after distal radius and ulna fracture is presented. This case illustrates an uncommon complication following a fairly common injury.

The wrist is a common site of injury in sports, both acute and chronic. Evaluation of wrist injuries requires knowledge of anatomy kinematics, attention to the mechanism of injury, the intensity of training, and a focus on the physical examination for specific injuries.

The primary prerequisites for optimal management of the athlete's fractured wrist are prompt diagnosis, anatomic and stable reduction, effective immobilization until healing is thorough, and comprehensive rehabilitation of the injured parts. Fulfillment of these fundamental criteria consistently leads to a highly favorable outcome with minimal risk of re-injury. In contrast, a compromise of these principles, especially for the sake of a speedy return to sports, invariably results in suboptimal recovery and, not infrequently, a permanent loss of skills. The exceptions to the cardinal rule that successful treatment of wrist fractures requires precise restoration of anatomic relationships are specific: displaced hamate hook fractures, displaced trapezial ridge fractures, and comminuted pisiform fractures. In such instances, successful union essentially is precluded, and early excision of the displaced fragments is the logical means of facilitating an uncomplicated recovery. For the more complex fractures requiring stabilization, continual refinements in methods of fixation are considerably diminishing fracture morbidity. The availability of small screws that provide rigid fixation of the carpus is, with increasing consistency, promoting accelerated union and rapid rehabilitation. Well-conceived combinations of low-profile, mechanically efficient external fixators and precisely used Kirschner wires achieve highly secure fracture stability for the distal radius that similarly enhances recovery with a minimum of complications. Improvements in both design and application of internal and external fixation techniques undoubtedly constitute a major advance in the management of wrist fractures among athletes. For some athletes, the return to competition can be safely expedited by the use of custom-fit protective gloves, splints, or casts. For most, however, the treatment regimen usually entails a minimum of 3 to 4 months. Although the healing and rehabilitation process is often lengthy and may seem costly, particularly in terms of time lost from competition, seldom do athletes regret the investment once they return to their highly skillful activities unencumbered by wrist impairment. Never does the sports medicine physician regret compliance with the principles of optimal care.

Closed-tendon injuries of the hand and wrist are very common in the athletic population. Most of these injuries, if seen acutely, can be treated successfully with nonoperative management, although some do require operative treatment. It is those injuries, however, that go undiagnosed until the end of the season, which may result in permanent disability.

We present a review of the current literature involving fractures of the pisiform and hook of the hamate. This is highlighted by two cases in which the fracture lines are seen only on the reverse oblique wrist radiograph, a view obtained with the wrist in a supinated rather than a pronated position. These fractures are not seen on standard two or three view wrist examination. Both of these fractures were initially missed in the emergency department. Serious sequelae can result from both of these injuries and can be avoided if diagnosed acutely. The reverse oblique radiograph can be quick, cost-effective, and diagnostic in this setting. If properly treated by immobilization or excision, the results can be excellent.