ABSTRACT
Treatment options depend on whether the fracture is intra- or extra-articular and the degree of fragmentation of the joint surface and the metaphysis. Displaced fractures must be reduced under anaesthesia (haematoma block, Bier's block or axillary block). For very unstable fractures and osteoporotic bone, external fixation may be added to prevent collapse around the wires. In the young adult, a comminuted intra-articular fracture is a high-energy injury. In fractures where the anatomy is not restored and there are identifiable fragments (computed tomography scanning can help to decide), open reduction and volar plate fixation may be necessary. The distal radius and ulna are among the commonest sites of childhood fractures. Complete fractures can be embarrassingly difficult to reduce especially if the ulna is intact. Injuries of the wrist comprise soft-tissue strains and fractures or dislocations of individual carpal bones. Scaphoid fractures account for almost 75% of all carpal fractures but are rare in children and in the elderly.
