Wrist Fractures: Distal Radius and Scaphoid Decision Points

Wrist fracture decisions turn on a few measurements, but the right threshold depends on the patient, the image, and the bone. In this episode of Plastics in Practice, we review distal radius and carpal fractures with an emphasis on reduction, fixation, and the diagnostic traps that change management. Key takeaways:• Document median nerve function and distal radioulnar joint stability before and after distal radius reduction.• In study-defined non-geriatric adults, post-reduction radial shortening greater than three millimeters, dorsal tilt greater than ten degrees, or intra-articular displacement or step-off greater than two millimeters supports operative fixation.¹• Age sixty-five is a study proxy, not a biologic cutoff. Functional demand and patient priorities still matter, and routine fixation has not improved long-term patient-reported outcomes in geriatric cohorts.¹• Fixation constructs have similar long-term outcomes; volar locking plates mainly offer earlier functional recovery.¹• A negative scaphoid radiograph does not close the case. Immobilize a clinically suspicious wrist, obtain early MRI for an occult fracture, and use long-axis CT when a fracture is visible.²• Initial below-elbow casting is appropriate for bicortical scaphoid waist fractures displaced two millimeters or less, with prompt fixation if nonunion is confirmed.²˒³• Fixation is favored beyond two millimeters of scaphoid waist displacement, for any displaced proximal-pole fracture, or with an unstable carpal injury. Confirm union before discharge.² This content is for education only and does not replace clinical judgment, institutional protocols, or individualized patient care. 🎧 Full episodes available now:Instagram: https://www.instagram.com/plasticsinpractice/ Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ 📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ #PlasticSurgery #HandSurgery #WristFracture #DistalRadiusFracture #ScaphoidFracture #SurgicalEducation #PlasticsInPractice References:1. American Academy of Orthopaedic Surgeons. Management of Distal Radius Fractures Evidence-Based Clinical Practice Guideline. Published December 5, 2020; adopted by the American Society for Surgery of the Hand May 22, 2021. https://www.aaos.org/globalassets/quality-and-practice-resources/distal-radius/drfcpg.pdf2. British Society for Surgery of the Hand. Scaphoid Fractures: Standards for Trauma. https://www.bssh.ac.uk/_userfiles/pages/files/professionals/Trauma%20standards/Scaphoid%20standards.pdf3. Dias JJ, et al. Surgery versus cast immobilisation for adults with a bicortical fracture of the scaphoid waist (SWIFFT). Lancet. 2020;396:390–401. doi:10.1016/S0140-6736(20)30931-4