What are the indications for referring a patient with a wrist fracture to secondary care for surgical intervention?

Refer a patient with a wrist fracture to secondary care for surgical intervention if the fracture is dorsally displaced and surgical fixation is indicated. Surgical fixation is recommended when:

• There is no fracture of the articular surface of the radial carpal joint or displacement of the radial carpal joint can be reduced by closed manipulation, in which case K-wire fixation is offered.
• Closed reduction of the radial carpal joint surface is not possible, in which case open reduction and internal fixation should be considered.
• In children with dorsally displaced distal radius fractures that are completely displaced (off-ended), K-wire fixation is considered after manipulation.
• Surgery should be performed within 72 hours of injury for intra-articular distal radius fractures and within 7 days for extra-articular fractures.

These criteria help identify patients who require surgical management rather than conservative treatment such as manipulation and plaster cast.

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