Beware of Hand and Wrist Injuries on Wet Floors

Walking in rainy and cold weather becomes quite difficult due to wet and slippery ground conditions. During winter months, wrist injuries from falls rank among the most common trauma cases. Problems that develop in the wrist lead to serious issues such as pain and restricted movement, which negatively affects patients' quality of life. Disorders in this region can be treated through open and closed surgical procedures. Prof. Dr. Mehmet Demirtaş from the Orthopedics and Traumatology Department at Memorial Ankara Hospital provided information on wrist injuries and treatment methods.

Most common are fractures of the wrist bone

Trauma to the hand and wrist region is classified into two categories: bone and soft tissue injuries.

Wrist bone fractures occur most frequently due to blunt force, falls, impacts and strain, while soft tissue injuries commonly involve tendon rupture and nerve damage.

In falls directly onto the open hand, either the wrist itself or the elbow fractures, with the wrist itself being most common and the scaphoid bone being the second most common fracture site. Unfortunately, fractures of this bone are not always readily apparent on imaging, but tenderness in this region should raise suspicion of a scaphoid fracture.

Fractures present with swelling, pain and restricted movement

Fractures typically manifest as swelling over the wrist and pain with or without movement. Radius fractures produce a fork-like deformity in the wrist, whereas small bone fractures do not.

When a fracture is suspected, the wrist must be immobilized and not moved. Diagnosis of fractures is made through physical examination and X-ray, with CT or MR imaging requested if necessary.

Some fractures require surgical intervention

Non-displaced, non-comminuted fractures are treated with casting, while displaced and comminuted fractures often cannot be reduced by closed reduction.

In such cases, surgical intervention is required, employing either internal or external fixation methods. For external fixation, external fixators are placed as a bridge between the hand and forearm.

In internal fixation procedures, particularly to correct step-offs in intra-articular fractures, screws are placed on both sides of a plate (a perforated metal device) during surgery for fracture fixation.

Arthroscopy is widely used in the wrist and thumb

Fluoroscopy and arthroscopy techniques are used in closed surgical procedures. In fluoroscopy, wires are passed through the skin without incision and fractures are fixed under fluoroscopic guidance.

In arthroscopy, very thin cameras are used to enter the joint through two or three small holes to perform procedures such as cleaning, tear repair, or nerve decompression. Arthroscopy is widely used in the wrist and thumb.

Tendon injuries are the priority in soft tissue injuries

Tendon lacerations are the primary concern in soft tissue injuries. The muscles surrounding the wrist, called tendons, when contracted taper at their ends and transmit force to the fingers like a thin rope.

This allows the fingers to close and the wrist to flex. When tendons are damaged in wrist injuries, the mechanism that allows fingers to bend inward or rise upward becomes compromised.

Loss of sensation can cause severe burns

Damage to hand nerves is the second most common soft tissue injury. Nerves in the hand that provide sensation transmit sensory information from the fingers to the brain like an electrical cable.

When a nerve is severed, patients lose sensation and cannot determine whether what they are holding is hot, cold, hard, soft or sharp. The inability of these patients to perceive temperature can lead to serious burns.

Nerves are repaired under the microscope

Treatment of tendon injuries and nerve damage is performed through open surgical methods. In this operation, tendons are exposed and sutured end-to-end. After the surgery, physical therapy and rehabilitation must be performed to release adhesions around the tendon.

In nerve damage cases, nerves are magnified under the microscope and repaired, with success rates of approximately 70-80 percent from this procedure.