What are cortical avulsion fractures within the wrist?

From the Guidelines

Cortical aversion fractures within the wrist should be assessed using CT without IV contrast, as it provides a detailed evaluation of the cortical and trabecular bone with high spatial resolution, ideal for assessing fracture healing, malunion, and articular surface incongruity 1. When evaluating cortical aversion fractures in the wrist, it is essential to consider the benefits of CT imaging, particularly in assessing the detailed structure of the bone. The use of CT without IV contrast has been shown to be beneficial in operative planning for scaphoid fracture 1. Some key points to consider in the management of cortical aversion fractures include:

• Immobilization with a splint or cast for 4-6 weeks, depending on fracture severity and location
• Pain management using NSAIDs, such as ibuprofen or naproxen, for 1-2 weeks
• Rest, ice application, and elevation above heart level to reduce swelling and pain
• Physical therapy to restore range of motion and strength after immobilization It is crucial to note that most avulsion fractures heal well with conservative treatment, but displaced fractures or those involving joint surfaces may require surgical fixation. In terms of imaging, CT is particularly useful in assessing the DRUJ, and can be used to image the symptomatic and contralateral wrist simultaneously in different positions to assess for instability 1. Overall, the management of cortical aversion fractures in the wrist should prioritize a detailed assessment of the fracture using CT imaging, followed by appropriate immobilization, pain management, and physical therapy to promote healing and restore function.

From the Research

Cortical Aversion Fractures within the Wrist

• Cortical aversion fractures are a type of fracture that occurs when a fragment of bone is pulled away from the main bone, often due to ligament or tendon avulsion 2
• These fractures can occur in various bones in the wrist, including the triquetrum, which is the second most commonly fractured carpal bone 2
• The treatment of cortical aversion fractures in the wrist often involves immobilization, either through casting or splinting, although surgical treatment may be necessary in some cases 2, 3
• Immobilization can lead to complications such as stiffness, pressure sores, and compartment syndrome, particularly if the cast or splint is applied incorrectly or if the patient is at high risk for complications 3
• Patients who have experienced a wrist fracture, including cortical aversion fractures, often report significant challenges during the recovery process, including changes to social role and increased dependence, as well as dissatisfaction with the level of empathy and communication from healthcare professionals 4

Predicting Outcomes

• Early post-immobilization pain at rest and movement-evoked pain can be potential predictors of pain and disability at 6- and 12-months after distal radius fracture, which may also be relevant to cortical aversion fractures in the wrist 5
• A study found that pain at rest (PAR) and movement evoked pain (MEP) scores at 2-months after distal radius fracture can predict the occurrence of chronic pain or disability at 6- and 12-months after the injury, although the ratio of these two pain indicators (MEPR) may not be as accurate a predictor 5