 Introduction/Background Hand injuries account for approximately 20% of emergency department visits [1]. According to the National Hospital Ambulatory Medical Care Survey, 1.5% of all emergency department visits involve hand and wrist fractures. Distal radius fractures are especially common, accounting for up to 18% of fractures in the elderly [2,3]. Because of increasing rates of osteoporosis, the incidence of distal radius fractures has been increasing [4]. Although most distal radius fractures in elderly patients are managed nonoperatively, the use of internal fixation is increasing. Internal fixation has a much higher cost than nonoperative treatment as well as increased rates of hospitalization [5]. For most patients with trauma to the hand and wrist, conventional radiographs provide sufficient diagnostic information to guide the treating physician. However, delayed diagnosis is common because distal radius and scaphoid fractures may be radiographically occult [6]. When initial radiographs are normal but there is high clinical suspicion for fracture, further imaging with additional radiographic projections, CT, or MRI is appropriate. If associated soft-tissue injury is clinically suspected, CT, CT arthrography, MRI, MR arthrography, or ultrasound (US) may be indicated [7-10]. Successful treatment of distal radius fractures requires restoration of radial length, inclination, and tilt, as well as the realignment of the articular fracture fragments [9,11]. The presence of a coronally oriented fracture line, die- punch depression, or more than three articular fracture fragments are common indications for operative reduction [8]. Operative fixation resulting in <2 mm of residual articular surface step-off is usually considered necessary to avoid long-term complications, such as osteoarthritis [9,12]. A standard 3-view radiographic examination of the hand shows most fractures and dislocations of the metacarpals and phalanges [13].
Acute Hand and Wrist Trauma.  Introduction/Background Hand injuries account for approximately 20% of emergency department visits [1]. According to the National Hospital Ambulatory Medical Care Survey, 1.5% of all emergency department visits involve hand and wrist fractures. Distal radius fractures are especially common, accounting for up to 18% of fractures in the elderly [2,3]. Because of increasing rates of osteoporosis, the incidence of distal radius fractures has been increasing [4]. Although most distal radius fractures in elderly patients are managed nonoperatively, the use of internal fixation is increasing. Internal fixation has a much higher cost than nonoperative treatment as well as increased rates of hospitalization [5]. For most patients with trauma to the hand and wrist, conventional radiographs provide sufficient diagnostic information to guide the treating physician. However, delayed diagnosis is common because distal radius and scaphoid fractures may be radiographically occult [6]. When initial radiographs are normal but there is high clinical suspicion for fracture, further imaging with additional radiographic projections, CT, or MRI is appropriate. If associated soft-tissue injury is clinically suspected, CT, CT arthrography, MRI, MR arthrography, or ultrasound (US) may be indicated [7-10]. Successful treatment of distal radius fractures requires restoration of radial length, inclination, and tilt, as well as the realignment of the articular fracture fragments [9,11]. The presence of a coronally oriented fracture line, die- punch depression, or more than three articular fracture fragments are common indications for operative reduction [8]. Operative fixation resulting in <2 mm of residual articular surface step-off is usually considered necessary to avoid long-term complications, such as osteoarthritis [9,12]. A standard 3-view radiographic examination of the hand shows most fractures and dislocations of the metacarpals and phalanges [13].