Sticks & Stones & Broken Bones

June 16, 2023

Although humans are capable of injuring themselves in an infinite variety of ways, the most common way is to fall over. The act of tripping and falling, whilst trying to protect oneself from harm by putting out an arm, produces a pattern of injury that varies with age.  

Young children have rubbery bones and tend to get injuries known as greenstick fractures of the wrist. Named after the way new wood breaks, these fractures usually heal very quickly without leaving any deformity.

Older individuals with brittle bones will snap the wrist across both the radius and the ulna in what is known as a Colles Fracture. Left untreated, this results in the self explanatory ‘dinner fork deformity’. Treatment involves applying anaesthesia and pulling down the length of the forearm before applying a cast.

As age accompanies brittle bones with slowed reactions, the dreaded hip fracture becomes the painful consequence of not being able to get the arm out in time. This will usually require replacement surgery.
Between young and old, the force of the impact is usually taken directly on the bones of the wrist itself. This can result in a fracture of the scaphoid bone, which lies just on the near side of the base of the thumb. Often dismissed as a ‘sprain’, it is important that this injury is not missed.

In an example, the ‘anatomical snuffbox’ in a wrist is filled by the blood as a result of a bony injury. The snuffbox will also be very tender. X-rays are often difficult to interpret. This example is much clearer than the typical hairline crack.

The reason it is so important to diagnose this fracture lies in the human design. If left to their own devices, bones will normally heal rapidly within six weeks. However, the scaphoid is an exception because when it fractures, it often breaks its own blood supply. A scaphoid fracture requires immobilization in a specific cast for three months. A failure to do this can result in a non-union or, worse still, avascular necrosis.

Watch out for those uneven pavements!

Dr Julian Martin Chadwick - Internal Medicine Physician
Columbia Asia Hospital - Saigon