EWJ June 61 2025 web - Flipbook - Page 37
Wrist Fractures in Medicolegal
Practice: Why the Outcome is
Rarely Perfect
Wrist fractures, particularly distal radius fractures, represent one of the most common injuries
encountered in trauma and orthopaedic practice. Their frequency, functional significance, and
the challenges they pose in management mean that wrist fractures feature prominently in
medicolegal work, especially where long-term symptoms or suboptimal outcomes arise.
In the medicolegal context, wrist fractures often
become the focus of litigation when recovery is incomplete, complications occur, or expectations exceed
the likely outcome of the injury. This article explores
the clinical aspects of wrist fractures most relevant to
medicolegal practice, including classification, management, complications, and factors influencing
prognosis. It highlights why wrist fractures rarely result in a truly ‘perfect’ recovery and provides expert
insight into the evaluation of such injuries from a
medicolegal perspective.
depends on factors such as:
• Position of the hand and wrist at impact
• Bone quality (normal vs osteoporotic)
• Energy of the trauma
High-energy injuries (such as motorbike accidents or
falls from significant height) can result in complex,
comminuted (multi-fragmentary) intra-articular fractures, whereas low-energy injuries in the elderly often
produce extra-articular, metaphyseal fractures (i.e. the
junction between the shaft of the bone and where it
flares to form the articular joint).
Epidemiology and Mechanisms of Injury
Frequency of Wrist Fractures
Wrist fractures, especially distal radius fractures, are
among the most common skeletal injuries, accounting for approximately 15% of all fractures seen in
emergency departments. There is a bimodal distribution:
• Young adults: high-energy trauma (e.g. sports
injuries, road traffic accidents)
Classification of Wrist Fractures
Several classification systems exist, but each has its
strengths and limitations in the context of medicolegal
work. However, classifications are rarely used in clinical practice beyond calling them intra-articular (i.e.
the fracture line(s) extend into the joint) or extraarticular; or using the eponymous names.
Descriptive Terminology
First it is important to understand the medical
terminology. The bone has a diaphysis (shaft), a metaphysis (the flared junction between the shaft and the
epiphysis), and an epiphysis (the end of the bone with
the cartilage on). The epiphysis fuses with the metaphysis when the patient reaches skeletal maturity and
stops growing at the end of puberty i.e. mid-teenage
years.
• Older adults (especially postmenopausal women):
low-energy trauma (e.g. falls from standing height),
often linked to osteoporosis.
The incidence of distal radius fractures increases
markedly in women over the age of 50 due to reduced
bone mineral density i.e. osteoporosis (“brittle bones”).
Mechanisms of Injury
The typical mechanism involves a Fall Onto an
Out-Stretched Hand (FOOSH injury), leading to axial
loading across the wrist. The specific pattern of injury
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The diaphysis/shaft is good at withstanding axial
compressive forces (or tension forces) but is slightly
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JUNE 2025
