Practice ABC of Emergency Radiology, 3rd Edition

Hand and Wrist

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g2174 (Published 18 June 2014) Cite this as: BMJ 2014;348:bmj.g2174
  1. Joe Coyle1,
  2. Ali Naraghi2,
  3. Otto Chan2
  1. University of Toronto Toronto, ON, Canada
  2. The London Independent Hospital London, UK

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Overview

  • Hands and wrist fractures account for 20% of acute fractures

  • Age alone can accurately predict most injuries

  • Plain radiographs remain the mainstay of imaging

  • MRI (and CT) are developing increasing roles

  • Aim is to restore function and avoid chronic disability

Injuries to the hand and wrist are very common, accounting for 20% of acute fractures presenting to emergency departments. The hand is the most active part of the body, is the least well protected and thus is often injured.

Most injuries to the wrist occur following a fall onto an outstretched hand (FOOSH). Mechanism of injury in these patients can accurately predict injury pattern. Age alone also can accurately predict likely fracture pattern (Table 1).

Clinical exam is usually accurate in this scenario and strong clinical suspicion for fracture can often direct close radiologic evaluation for subtle abnormalities.

The goal of treatment is rapid restoration of function with attention given to the prevention of chronic disability. Plain radiographs are the mainstay of imaging. Computed tomography (CT) and magnetic resonance imaging (MRI) are developing increasing roles, particularly as their availability increases.

Anatomy

Hand

Each ray, apart from the thumb, consists of a metacarpal and proximal, middle and distal phalanges. The thumb has a metacarpal and proximal and distal phalanges. At each metacarpophalangeal (MCP) joint and interphalangeal (IP) joint, lateral stability is provided by the collateral ligaments. The joint capsule at the MCP and IP joints also demonstrate on the volar aspect areas of dense fibrous thickening, known as the volar plate, which provide …

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