From the Guidelines
Cortical avulsion fractures within the wrist are injuries where a small fragment of bone is pulled away from the main bone by an attached ligament or tendon during trauma, typically occurring during falls on an outstretched hand, sports injuries, or other wrist trauma. These fractures usually happen when the strong ligaments remain intact but pull off a piece of bone at their attachment site.
Common Locations and Diagnosis
Common locations for these fractures include the ulnar styloid, radial styloid, and dorsal rim of the distal radius. Diagnosis requires imaging, usually starting with X-rays, though CT scans may be needed for better visualization, as indicated by the American College of Radiology Appropriateness Criteria 1. According to the criteria, radiography is always indicated as the initial imaging for suspected acute hand and wrist trauma, and a standard 3-view radiographic examination of the wrist usually includes a posteroanterior (PA), a lateral, and a 45 semipronated oblique view 1.
Treatment and Prognosis
Treatment depends on the size of the fragment and its displacement.
- Small, non-displaced avulsion fractures often heal well with conservative management including immobilization with a cast or splint for 4-6 weeks, followed by gradual rehabilitation exercises.
- Larger or significantly displaced fragments may require surgical fixation using pins, screws, or suture anchors to restore proper alignment and function. These fractures generally have a good prognosis when properly treated, though rehabilitation is important to restore range of motion and strength, as emphasized by the guidelines 1. Complications can include stiffness, chronic pain, or instability if not adequately managed. It is essential to follow the recommended imaging and treatment procedures to ensure the best possible outcome for patients with cortical avulsion fractures within the wrist.
From the Research
Cortical Aversion Fractures within the Wrist
- Cortical aversion fractures refer to a type of fracture where a fragment of cortical bone is broken off from the main bone structure.
- In the context of wrist fractures, cortical aversion fractures can occur in various carpal bones, including the triquetrum and distal radius.
- The triquetrum is the second most commonly fractured carpal bone, and dorsal cortical fractures are the most common type of triquetral fracture, usually benign 2.
- Volar Barton fractures of the distal radius can also involve a dorsal cortical break, which can affect surgical strategy, and occur in approximately 75% of cases 3.
- Cortical aversion fractures can be caused by various mechanisms, including falls on an outstretched hand, impaction of the ulnar wrist, or avulsion of attached ligaments 2.
- Diagnosis of cortical aversion fractures can be challenging, and may require advanced imaging techniques such as computed tomography (CT) scans to accurately identify the fracture pattern 3.
- Treatment of cortical aversion fractures depends on the location, severity, and displacement of the fracture, and may involve immobilization, surgical fixation, or other management strategies 4, 2, 3.