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A study of wrist injuries in children: the incidence of various injuries and of premature closure of the distal radial growth plate.

There were 362 wrist injuries in 359 patients under 18 years of age who attended the Accident & Emergency Department, St James's University Hospital, Leeds, over a 1-year period. These included soft tissue injuries (53%), epiphyseal injuries (4%) and fractures of the distal forearm or carpus (43%) which were reviewed 3 years after injury. At re-examination, a repeat X-ray was undertaken and this showed evidence of premature epiphyseal fusion in three of the 281 who returned for review and in these three patients there was a history of persistent symptoms in the affected wrist or forearm. It is suggested that patients with an obvious epiphyseal injury or those who have persistent symptoms following an injury to the wrist should be followed carefully to skeletal maturity in order to detect early partial or total closure of the growth plate.

Adolescent

Hand and wrist injuries in the athlete.

Injuries to the hand and wrist are probably among the most common injuries incurred by the athlete. Neglect of such injuries may result in irreparable damage to the hand or wrist. This summary of the more common injuries to these areas seen in the athlete, with a description of the recognition and treatment, gives the reader insight into the multiple considerations the athlete and coach must have. Even seemingly minor injuries must be carefully evaluated and treated by a physician. Early diagnosis, accurate precise treatment, and proper rehabilitation are extremely important to regain optimal function after these injuries. They may have a significant impact not only in athletic competition but also in the athlete's selection of an occupation. It is psychologically important also that the participant be returned to his particular sport as soon as possible. Most of the injuries can be controlled by conservative means. However, when surgical repair is indicated, it is important for the surgeon to be trained and familiar with the anatomy and techniques of surgery of the hand and wrist.

Athletic Injuries

The role of arthroscopy in the treatment of wrist injuries in the athlete.

As a minimally invasive procedure, wrist arthroscopy provides the advantages of accurate, direct visual inspection of intra-articular structures for diagnostic purposes and dramatically reduced morbidity for surgical treatment of certain disorders. For an athlete who has a limited window of opportunity to compete, arthroscopy can offer an earlier, more accurate, more complete diagnosis than other imaging techniques for soft-tissue disorders of the wrist. Arthroscopic surgery can frequently offer an abbreviated recuperation period and earlier return to competition. Arthroscopy offers advantageous treatment options for extrinsic and intrinsic ligament injuries, removal of loose bodies, reduction of articular fractures of the distal radius and scaphoid and definitive treatment of injuries to the triangular fibrocartilage complex. It is a modality well worth including in the treatment armamentarium for wrist disorders in athletes.

Arthroscopy

Hand and wrist injuries in the preadolescent and adolescent athlete.

In this time when physical prowess has been elevated to such a high level, the prepubescent and adolescent athlete have increased demands for performance placed on their immature musculoskeletal system. Although improved skills may result the athlete is exposed to more injury. Prompt, appropriate treatment of the injury with a controlled return to participation may prevent reinjury and disability. To this end, athletes, parents, coaches, trainers, and team physicians must maintain a close rapport for the benefit of the athlete.

Adolescent

Rehabilitation techniques for ligament injuries of the wrist.

The goal of treatment after any wrist injury is a pain-free, stable joint with sufficient strength and mobility to carry out the daily recreational, and occupational tasks required by the individual. Treatment varies considerably depending on the age of the patient, the severity of the initial injury, the operative procedure performed, and the specific guidelines requested by the referring physician.

Adolescent

Rupture of the extensor pollicis longus tendon without fracture after wrist trauma: case reports.

Four cases of rupture of the tendon of the extensor pollicis longus without detectable fracture after wrist injury are reported. The clinical features of this condition did not differ materially from those of rupture occurring after a Colles fracture. All patients were rather young, the average age being 40 years. In one patient rupture occurred a day after injury. In all patients satisfactory thumb function was restored with extensor indicis proprius tendon transfer.

Adult

Acute ulnar neuropathy with fractures at the wrist.

Injury to the ulnar nerve associated with or following a fracture at the wrist is unusual. Three cases of this association are presented. Previously reported cases have been reviewed. The associated lesions tend to occur in young adults after higher-energy trauma and more dorsal displacement of the distal radial fragment than are generally seen in patients with Colles fractures. The return of function in the three wrists was related to the promptness and accuracy of reduction of the fracture and to the decompression of the ulnar nerve in Guyon's canal. We present a regimen for treatment of this injury stressing accurate reduction of the fracture and early surgical decompression when necessary.

Adult

Ligamentous injuries of the wrist in athletes.

The athlete's wrist is particularly prone to injury. Although many wrist injuries are dismissed as sprains or strains, a number of these injuries involve significant ligamentous damage that can lead to chronic carpal instability. A complete knowledge of the carpal ligamentous anatomy and classification of wrist instability patterns is necessary for the adequate diagnosis and treatment of these injuries.

Arthroscopy

The wrist: field evaluation and treatment.

A poorly diagnosed and treated wrist injury could become a career-ending injury. Optimal treatment begins on the playing field, not the operative field. A careful, thorough field evaluation is mandatory to ensure prompt recognition of a potentially debilitating injury. Suspected fractures or ligamentous disruption require immediate referral to a physician for definitive early treatment. When the trainer and physician work as a team, early diagnosis, treatment, and rehabilitation of wrist injuries can be instituted to reach the goal of maintaining functional healthy wrists for future athletic endeavors.

Athletic Injuries

Ligamentous injuries to the wrist. Imaging techniques.

The variety of imaging techniques available to the clinician facilitates the diagnosis of acute and chronic wrist disorders. In most cases, conventional radiographs provide sufficient information. Computed and trispiral tomography, arthrography, video-fluoroscopy, and magnetic resonance imaging are additional imaging techniques that are useful in making the correct diagnosis and deciding on a course of treatment.

Carpal Bones

The ligaments of the human wrist and their functional significance.

The ligamentous anatomy of the wrist was analyzed by studying (1) 28 dissected human wrists, (2) and by examination of 19 wrist injuries created mechanically. Six volar intracapsular ligaments are described, two stabilizing the distal carpal row, three stabilizing the proximal carpal row and one stabilizing the proximal scaphoid pole. More specific terminology for these ligaments is proposed. An explanation of how these ligaments participate in the mechanical functioning of the carpus is advanced. Mechanically created wrist injuries had ruptures of specific ligaments as described augmenting a need for a more specific terminology. Suspected mechanisms of injury in perilunate and lunate dislocations are mentioned based upon the functional understanding of the intracapsular ligaments.

Adult

[Habitual scapholunar dissociation].

The authors discuss a rare form of wrist injury, involving scapholunar dissociation, which is manifested by subluxation of the scaphoid bone. The radiologic, clinical, and therapeutic aspects are described. The authors also represent a case of their own where the subluxation of the scaphoid bone became habitual.

Adult

'Soccer supporter's wrist'.

Hyperextension injury to the wrists occured in seven adolescents attending football matches in this country. Clinical details of these injuries are recorded and the mechanism of injury is discussed.

Accident Prevention