Most important wrist fracture types and their respective clinical presentations are:

• Distal radius fractures - Being the most common type of wrist fracture, distal radius fracture encompasses 17% of all fractures seen in the emergency department, and falling onto an outstretched hand (often encountered in ice hockey players and both ice and inline skaters) is the main mechanism of injury [1] [2]. Swelling of the wrist, a limited range of motion, tenderness along the distal radius and injury of the median nerve leading to numbness of the tip of the index finger can be observed during physical examination [2] [3].
• Scaphoid fracture - Seen in previously healthy and young individuals who either fall on the outstretched arm or provoke a forced dorsiflexion of the wrist, this type of fracture presents with tenderness over the anatomic snuff box or the distal scaphoid tubercle, accompanied by a limited range of motion [4]. Pain and reduced grip strength are infrequently reported [4].
• Lunate fracture - Similarly to scaphoid and distal radius fractures, injury to the lunate bone occurs after falling onto an outstretched hand [1], but compression injury or a direct blow to the wrist may be responsible as well [1] [5]. It is very rarely encountered in practice, and wrist pain may be the only clinical sign [5].
• The hook of hamate fracture - Baseball, golf, and tennis players are shown to be at the highest risk for this type of fracture since transmission of the force from the bat, club or racquet to the palm is the mechanism of fracture [2]. Ulnar or median nerve injury manifesting as numbness, as well as wrist pain, are main complaints.
• Triquetrum fracture - Dorsal cortical fracture of the triquetrum is regarded as the second most common carpal fracture (after scaphoid) [2], and symptoms include nonspecific tenderness and swelling. The diagnosis is frequently misinterpreted as wrist sprain, however, which is why detailed radiographic workups are imperative in distinguishing between different types of injury [1] [2].
• Trapezium - Direct high-level impact to the bone is the main mode of fracture, and is frequently associated with distal radial injury [2].

Patient history and findings observed during the physical examination are sufficient in turning the physician's attention to a wrist-related pathology, but imaging studies are necessary to confirm the presence of a fracture. Plain radiography of the injured wrist is an excellent initial method, but only if images are obtained in the adequate plane, depending on the site of injury [1]. For example, scaphoid fractures require a lateral radiographic view, while distal radius fractures require both posteroanterior (PA) and lateral views, an external oblique projection and a PA image with ulnar deviation of the wrist [1]. If the cause of symptoms is undisclosed with plain radiography, more sensitive imaging methods should be employed. Ultrasonography is recommended in the setting of suspected scaphoid fractures [6], but it is regarded as an inferior procedure compared to computed tomography (CT) and magnetic resonance imaging (MRI), described as the gold standard in imaging workup of the wrist [2] [7]. These procedures can determine the exact site of fracture with great efficacy, and more importantly, determine the presence of other potential injuries (e.g., soft tissue injuries such as ligament tears or additional fractures) [2], which is why they are often recommended in early workup [2] [7]. In some patients, technetium 99 (99 Te) bone scintigraphy may be used as a diagnostic tool [1].

1. Goldfarb CA, Yin Y, Gilula LA, Fisher AJ, Boyer MI. Wrist fractures: what the clinician wants to know. Radiology. 2001;219(1):11-28.
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3. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
4. Steinmann SP, Adams JE. Scaphoid fractures and nonunions: diagnosis and treatment. J Orthop Sci. 2006;11(4):424-431.
5. Galbraith PJ, Richardson ML. Fracture of the Lunate: Radiographic Findings and Case Report. Radiol Case Rep. 2007;2(1):13-16.
6. Senall JA, Failla JM, Bouffard JA, van Holsbeeck M. Ultrasound for the early diagnosis of clinically suspected scaphoid fracture. J Hand Surg Am. 2004;29(3):400-405.
7. Murthy NS, Ringler MD. MR Imaging of Carpal Fractures. Magn Reson Imaging Clin N Am. 2015;23(3):405-416.