WRIST INJURIES

Wrist injuries are one of the most common sources of injuries amongst the snowboarders. It is especially seen in the beginners. The time most likely to sustain a wrist injury is in the first week, on a hard-packed/icy snow conditions. Wrist injuries are also sustained mainly as lower speeds, as it seems the person has more time to put his/her hand in theout-stretched manner, reflexly, to break their fall.

It is important for the beginner to fall in the correct manner as to avoid hurting their wrist. This is a learned phenomena, as it goes against the natural instinct of the boarder. Hence, get some lessons from a qualifed person.

Fractures

Fractures around the wrist can involve a number of bones. The main ones broken whilst snowboarding are: the

• Radius,
• Ulna and
• Scaphoid.

The commonest fracture being a break at the distal(wrist) end of the radius. The exact nature of the break varies with the age of the patient and the amount of force taken to cause the fracture.

Green-Stick

In the younger age group, there usually is no complete break of the bone, On X-ray it may looks like a break in a green twig/branch, hence the term 'Green-Stick', or there may only be a 'Buckling' of the bone, giving clue to the underlying injury. Hence there is a wide range of severity of this type of break.

Radial Fractures

These are the comonest types of break, and can either involve the joint or be outwith the joint.

Clinical Features of this break are:

Pain.

This is usually at the wrist. It could vary from a dull throbbing ache to the more usual sharp pain, which is worse on movement of the wrist or arm.

Swelling.

Swelling around the wrist following a break can be immediately obvious with bruising which dramatically indicates a break. In other cases, the swelling and bruising can be minimal and require a more observant assessment.

Deformity.

In the classical breaks of the radius, there is an obvious deformityof the wrist. This can be in the shape of an 'dinner-fork' laid upside down.

Management:

Most of these fractures in the younger age group of the lower velocity ones, are either undisplaced or minamilly displaced. 1 2 For these cases, the surgeon may elect to just put in a plaster cast( or whatever other immobilisation method perferred) and regularly observed.

In the more displaced breaks,(3) or those involving the joint, the surgeon may elect to align the bones when the limb is anaesthetised. This may take in the form of:

• General Anaesthesia
• Bier's Block: a cuff is placed over the affected arm, inflated and a local anaesthetic is injected into the arm, with the cuff inflated. This takes about 10-15mins to work.
• Haematoma Block: an injection of local anesthetic is made directly into the site where the fracture is hence numbing the affected site.

The surgeon reducing the frature will have his/her own perferred method, which according to their experience gives the best results, so discuss the options with them, if you have any queries or previous problems.

Once anaesthetised, the bones can then be aligned without much discomfort.

HOLDING THE FRACTURE

Once reduced holding the fracture is the main concern. This is done in two main ways:

External Splintage: ie Plaster of Paris. This is the easiest-or most difficult, according to some-method of holding the arm.

Internal Splintage: This method usually involves an operation to open the site and place metalwork of variable types depending on the prefered method and skill of the surgeon. This is usually embarked on more complicated fractures where it is absolutely necessary to get a perfect reduction of the fracture components, as to prevent loss of function of the wrist or future development of arthritis in the joint.

One may also find an External Fixator being placed to hold the bones together. This instrument is like a clamp which has pins placed on either side of the fracture sites, and this holds the fracture alignment.

The fracture needs to be immobilised anywhere between 4 - 6 weeks depending on the nature of the break, and the experience of the surgeon

MOVEMENT

Whilst the wrist is being immobilised, it is of utmost importance to excercise the hands, elbow and shoulder on a regular basis. JOINTS STIFFEN MUCH QUICKER THAN YOU THINK!

Following removal of your plaster the wrist will be very stiff and will require very aggressive physiotherapy, which involves mainly yourself excercising the wrist to bring the range of movement closer to that of the otherside.
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Fractured Ulna

Thes fractures are usually following a fall associated with a fracture of the Radius,(3) hence the treatment for both of them together. A fracture of both the Ulna and Radius usually means an unstable fracture, which is more liable to 'slip'. This should be borne in mind before thinking that the aneasthetic you had to bring together the ends is all there is, as you may require another manipulation of the fracture in the following 2-3 weeks.
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SCAPHOID

Scaphoid fractures are usually missed! One needs an acute assessment of painful wrist to prevent missing these breaks. Usually the initial X-Ray will show no break, and be led into a false sense of security.

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It is wise to immobilise the wrist in plaster, treating it as a fracture, and re-X-ray the hand after a fortnight, for it is then, whilst the healing process is underway, that the 'Fracture-Line' is visible.

Symptoms Pain in the wrist, with minimal swelling usually. The pain is mainly over the base of the thumb, and if pressured in a particular spot-ANATOMICAL SNUFF BOX- the clinical suspicion should be aroused

Management: Usually involves a 'Scaphoid Plaster' for a total of 5-6 weeks

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