Trauma to the hand is common but also important because it can cause cosmetic and functional damage out of all proportion to the severity of the initial injury.

Both will be important in determining the structures likely to have been injured. A stabbing injury may damage a nerve, while a crushing injury could lead to a compartment syndrome in the intrinsic muscles. Distal neurovascular status must always be tested as nerve damage is easy to miss.

These can injure structures all the way down the arm (see Chapter 8) but most commonly affect the writst.

Fractures of the distal radius are very common, especially in the elderly with osteoporosis. The fracture produces a classic ‘dinner fork’-type deformity (the Colles’ fracture). Because the bones are crushed together, the fracture is stable. So, if it is decided to leave the fracture as it is rather than reduce it, a soft removable splint for comfort may be all that is needed. This will be much easier for the patient to cope with than the heavy plaster that is needed for many weeks if the fracture is reduced and so made unstable.

A distal radial fracture in the non-elderly is a very different injury and should not be called a Colles’ fracture. It is a high velocity injury in hard bone where the fracture enters the joint and is unstable. This fracture almost certainly needs open reduction with internal fixation using a moulded plate if stiffness and arthritis in the joint are to be avoided.

Falls may also damage the carpal bones. The commonest of these results in tenderness over the base of the thumb, and is the result of a scaphoid fracture