Sports Related Hand
and wrist Injuries
Diagnosis and Management
Stephen Olmsted, MD
No disclosures to report.
Sport Specific Injuries
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Ball sports --- Finger avulsion fractures
Gymnastics --- Physeal stress fractures
Golf --- Hook of the Hamate fractures
Boxing --- Metacarpal fractures
Skiing --- Thumb fractures
Snowboarding- Wrist Fracture/dislocation
- high energy injuries
Contact Sports– Scaphoid Fx & Radius Fx
Return to Sports
 Pressure
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to return
athlete, team, parents and coaches
Athlete can physically perform (no hands)
 Soccer, Snowboard, Track, Football
 Adequate
protection –
 cast, splint, tape
Return to Sports
 Risk/Benefit
ratio
 Prolong injury, re-injury, worse injury
 Benefit to the team and/or athlete
 Individualize
the decision
 Type of Fracture – Joint, unstable, location
 Age, Level, Sport, Financial
 Make sure everyone knows the consequences
Decision Making
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Early Diagnosis – crucial
Joint Involvement
Fracture Stability
Type of Sport
Ability to protect adequately
Age and Level of Play
Off season vs Peak season
Risks of re-injury or irreparable damage
Boney Mallet Fracture
Treatment depends on joint involvement
 Most with small avulsion treated closed
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◦ Stack splint – extension splint for 6 wks
◦ Early return to sports in splint
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If 50% joint involved often needs pins
Volar Plate Avulsion Fracture
• Stable injury – brief splinting for comfort
• Early Range of Motion Ideal - full motion in 1-2
weeks
• Joint reduced, congruent
• Early return to activity and sport as comfort allows
Volar Plate Avulsion Fracture
Unstable injury - comminution
Joint incongruency
Needs more aggressive treatment
Condylar fractures
Joint step-off and incongruency
Vertical fracture - unstable
Poor results with immobilization
Condylar fractures
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Rotational Deformity – requires correction
Extra-articular fractures
Many treated closed, protected activity
Unstable, angular deformity, tendon imbalance
Middle Phalanx
Proximal Phalanx
Metacarpal Fractures
Common injuries in many contact sports
 Often seen with punching, may see signs of old injury
 Many treated closed with early return to sport
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Metacarpal Fractures
Look closely for rotational deformity
Excessive angular deformity or shortening should be corrected
Multiple metacarpal fractures often require surgery
Some that look unstable heal with normal function
Ulnar Collateral Avulsion Fx
Skier’s Thumb Mechanism
Ulnar Collateral Ligament Instability
Joint involvement with joint incongruency
Requires surgical reduction and fixation
Ulnar Collateral Avulsion Fx
Collateral Ligament stability restored
Joint congruency restored
Hook of the Hamate fracture
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Golf, Baseball, Hockey
Impact associated with Grip,Ulnar Deviation
May begin as a stress fracture
Often treated with excision, acute fx may heal
Scaphoid Fractures
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Common injury from fall in sports
May not have much pain or swelling
Often UN-diagnosed or MIS-diagnosed
Frequently diagnosed as Sprain
Radial Wrist Pain (snuff box tenderness)
Should be ruled out before returning
May consider MRI to R/O
Scaphoid Fractures
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Tubercle fractures – stable return to sport protected
Distal Pole Fx - Flexion Deformity, carpal malalignment
Waist Fx – most common, AVN or flexion deformity
Proximal pole Fx – High Risk AVN, Alignment Perserved
Untreated Scaphoid fx – Lead to Non-unions
Untreated nonunions – Lead to Arthritis
Scaphoid Fractures
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Distal Scaphoid fractures
 Often lead to Flexion Deformity and Carpal
Malalignment : Less risk of AVN
 Comminution makes less stable
Scaphoid Fractures -Waist
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Scaphoid Waist Fractures - most common
Avascular Necrosis or Flexion deformity
Non-displaced-Cast or Percutaneous Screw
Displaced – ORIF
Non-Union – ORIF with Bone Graft
Scaphoid Fractures-Proximal Pole
Carpal Alignment Maintained
 Avascular Necrosis Poor healing
 Bone resorption, cystic changes
 Often Require Surgical Treatment
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Diagnosis ?
Power Clean weight lifting injury
Trans-Scaphoid Perilunate
dislocation
Trans-scaphoid Perilunate
Dislocation –ORIF scaphoid
Gymnastics
Distal Radius Physeal Stress Fractures
Distal Radius Physeal Stress Fx
Rest, Immobilization, reduce impact and stress
Prognosis – excellent with early diagnosis
Untreated can result in Physeal accellaration or arrest
Ulnar positive or Ulnar negative variance
Distal Radius Fractures
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Most Common Fracture
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Fall onto Outstretched Upper Extremity
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Can be Stable or Unstable
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Can be Extra-articular or Intra-articular
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High Energy Injuries - unstable
Distal Radius Fractures
Snowboarding and Terrain Parks – More
High Energy Injuries
Salter II Distal Radius Fractures
Common Pediatric Injury - Fall
 Tx - depends on age, displaced, stability
 More conservative : wait to return to sport
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Distal Radius Fractures
May appear stable but can displace in cast
Distal Radius Fractures