5 Must-Know Wrist Fractures

As a student radiographer who's spent countless hours on wrist fractures, I've got your back with the top 5 you'll encounter in class and practice. Want to ace your exams and impress everyone? Check out my handy infographic—it's a lifesaver for study time!

Here’s what you will get:

No need to stop here—I've broken down the info below into easy bites to kickstart your revision journey. Let's dive in!

Disclaimer: I’m a radiography student sharing my revision notes to help you get started—think of this as a study nudge, not medical advice! I’m not a licensed professional (yet!), so always consult a qualified radiographer or doctor for clinical decisions. Use these notes as a springboard for your own study—let’s make wrists your exam superpower together!

Let's get an overview of some of the most common wrist fractures you'll encounter in radiography. Think of these five as essential knowledge: Colles fracture with its characteristic backward angulation, Smith's fracture which is the opposite with forward angulation, scaphoid fractures often subtle in the carpal bones, distal ulna fractures that can occur alongside radius injuries, and Barton's fracture involving a fracture of the radius rim. I've put together a visual guide highlighting the key X-ray sign for each of these to give you a quick reference. This is designed to be a helpful starting point before we delve into each fracture in more detail, making it easier to recognize them.

Colles Fracture:

First, let's discuss the Colles fracture, a very common injury. It typically happens when someone falls on an outstretched hand. On an X-ray, a key finding is dorsal tilt, where the end of the radius bone angles backward slightly. Clinically, this can result in what's often called a 'dinner fork' deformity due to the shape of the wrist, accompanied by swelling and tenderness. This is a fundamental fracture to understand as you'll likely see it frequently in practice. Mastering the identification of a Colles fracture is a great foundation for your diagnostic skills.

Smith's Fracture:

Next up is the Smith's fracture, which you can think of as the reverse of a Colles fracture. Instead of a fall on an outstretched hand, this usually occurs when the wrist is flexed at the time of injury, such as landing on the back of a bent hand or receiving a direct blow. On an X-ray, the distinguishing feature is volar tilt, where the end of the radius angles forward. Clinically, it might present with swelling and pain, but the 'dinner fork' deformity is typically absent. Smith's fractures can be a bit more challenging to identify, so careful review of the lateral X-ray is crucial. Recognizing this fracture demonstrates a good eye for detail.

Scaphoid Fracture:

Now, let's talk about the scaphoid fracture, which can be a bit tricky. It also commonly results from a fall on an outstretched hand, but the break occurs in the scaphoid bone, one of the small carpal bones near the thumb. Clinically, a key indicator is pain in the anatomical snuffbox – that small depression on the thumb side of the wrist. However, scaphoid fractures can sometimes be difficult to see on initial X-rays, so follow-up imaging might be necessary. Being aware of the mechanism and the snuffbox tenderness is important for suspecting this injury. Recognizing a scaphoid fracture is a significant step in developing your diagnostic acumen.

Distal Ulna Fracture:

The distal ulna fracture often occurs in conjunction with a radius fracture, such as in a Galeazzi fracture, where the radius breaks and the ulna dislocates at the wrist. However, the distal ulna can also fracture in isolation, usually due to a direct blow. On an X-ray, you'll be looking for a fracture line in the distal ulna, and it's always important to assess the alignment between the radius and ulna. Clinically, patients will typically present with pain and swelling on the little finger side of the wrist, and there might be instability depending on the severity. Understanding how distal ulna fractures relate to other wrist injuries is a valuable part of your learning.

Barton's Fracture:

Finally, let's discuss the Barton's fracture. This is usually a result of higher-energy trauma, like a car accident or a significant fall. It involves a fracture of the rim of the distal radius, which can be either on the back (dorsal) or palm side (volar) of the wrist, and often involves the wrist joint. On X-rays, you'll see a fracture line extending into the joint, along with displacement of the fractured rim. Clinically, there will be significant swelling, stiffness, and pain. Recognizing a Barton's fracture indicates an understanding of more complex wrist injuries.

Wrist Fracture Revision Table

To help you consolidate your knowledge of these five fractures, consider creating a simple table summarizing the key features. Include the typical injury mechanism (how it happens), the main X-ray finding (what to look for on the image), and a key clinical point (what you might observe in a patient). For example, for Colles: Fall on outstretched hand, Dorsal tilt, 'Dinner fork' deformity. Creating and reviewing such a table can be a very effective way to quickly recall the essential information for each fracture.

We've covered five important wrist fractures. If you're new to this, be sure to check out 'Why the Wrist Matters' for a foundational understanding, and 'Colles Fracture Made Simple' for a more in-depth look at that common injury. What wrist fracture do you find the most challenging to identify, or which one are you focusing on for your next exam? Share your experiences in the comments below.