The management of wrist injuries: An international perspective Marc Garcia-Elias a, * , Miguel A ´ ngel Vidal Folgar b a Institut Kaplan, Hand and Upper Extremity Surgery, Passeig de la Bonanova, 9, 2on 2a, 08022 Barcelona, Spain b Department of Orthopedics and Traumatology, Hospital Torreca´rdenas, Almerı ´a, Spain Introduction Wrist fusion has long been said to impair hand func- tion minimally, allowing most patients to return to their professional and vocational activities without apparent difficulties. 25 Some recent, more careful functional studies, however, have demonstrated this view not to be fully correct. 18,70 Indeed, for the hand to perform most activities of daily living efficiently there is a need for a mobile wrist which is able to sustain physiologic loads without yielding. Full grip strength, for instance, can not be achieved unless there is a concomitant powerful muscle contraction causing wrist extension. 36 Without a painless mobile wrist one can not cope effectively with such common activities such as dusting low surfaces, washing one’s back, or fastening a brassiere. 47 Certainly, the wrist is Injury, Int. J. Care Injured (2006) 37, 1049—1056 www.elsevier.com/locate/injury KEYWORDS Wrist trauma; Epidemiology of hand injury; Osteoporosis; Clinical examination of the wrist; Fracture of the distal radius; Scaphoid fracture; Closed reduction; External fixation; Osteosynthesis of the wrist; Non-operative treatment; Hand therapy Summary Wrist injury is common and may significantly impair the overall function of the upper extremity unless properly managed. Fractures of the distal radius are particularly common among the aging population, accounting for nearly 1/6 of all fractures, often as a result of increased longevity with the subsequent underlying osteoporosis. New diagnostic tools, including wrist arthroscopy, magnetic resonance imaging, or computed tomography, are increasingly available in developed countries allowing accurate recognition and more effective resolution of lesions which would be otherwise missed using conventional methods. First world treatment standards, however, can scarcely be introduced in developing countries owing to, among other factors, different prevalence of problems, and the lack of resource to implement most modern technologies. If any program needs to be introduced that meets the demands of wrist injury management in the third world, aside from a better regionalisation of trauma care, it should emphasise adequate training of professionals in the use of more cost effective techniques of fracture reduction and stabilisation, applicable every- where, with the minimum possible morbidity. # 2006 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +34 934 178 484; fax: +34 932 110 402. E-mail address: garciaelias@infonegocio.com (M. Garcia-Elias). 0020–1383/$ — see front matter # 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2006.07.025