Synopsis
Assess distal-radius deformity and median-nerve risk, detect occult scaphoid injury, use timely reduction and appropriate MRI or fixation pathways, and prevent collapse, nonunion and stiffness.
- Remove rings and inspect deformity, wounds and skin; document median, anterior interosseous, ulnar and radial motor and sensory function and perfusion.
- Obtain PA and lateral wrist radiographs for distal-radius injury and dedicated scaphoid views when radial-sided tenderness is present.
- Reduce severe displacement promptly under adequate analgesia, apply a well-moulded splint and repeat neurovascular examination and radiographs.
Key red flags
Progressive median paraesthesia, thenar weakness, severe volar swelling or increasing pain after reduction suggests acute carpal-tunnel compromise.
Dinner-fork deformity, swelling and wrist pain follow a fall on the outstretched hand.
Investigation priorities
Define distal-radius displacement, articular extension and carpal alignment.
Confirm occult fracture and identify alternative bone or soft-tissue injury early.
Management branches
A displaced distal-radius fracture presents with deformity or nerve and skin concern.
- Remove rings, give analgesia and document skin, perfusion and named nerve functions.
- Perform controlled reduction with suitable anaesthesia, apply a moulded splint and repeat examination.
Key medicines
Paracetamol for adult wrist painUse an oral adult dose of 500 mg to 1 g when required, separated by 4 hours or longer and capped at four doses during 24 hours.
Intravenous regional anaesthesiaUse the local weight-based prilocaine or approved local-anaesthetic regimen only in a monitored setting with trained staff, correct tourniquet technique and toxicity rescue.