It is the most common wrist fracture which usually follows a fall on outstretched hand. The fracture occurs within 1 inch of the distal end of the commonest fractures of middle and old age (common in osteoporotic bone). The fracture occurs at cortico-cancellous junction of the bone.

Clinical features:

1. Swelling, ecchymosis, tenderness
2. "Dinner fork" deformity
3. Assess neurovascular status (carpal tunnel syndrome)

X-ray: Distal fragment is -

1. Dorsally displaced and dorsally tilted
2. Radially displaced and radially tilted
3. Supinated
4. Impacted
5. Shortened (radial styloid normally 1cm distal to ulna)
6. +/- fracture of ulnar styloid

Complications:

1. Median nerve injury
2. Malunion
3. Rupture of extensor pollicis tendon
4. Complex regional pain syndrome

Boxer's fracture refers to the fracture of neck of 5th metacarpal bone (little finger) and often follows a blow with the fist. There may be local swelling, with flattening of knuckle. X-rays show an impacted transverse fracture with volar angulation of the distal fragment.

Non-Operative treatment:
A flexion deformity of up to 40 degrees can be accepted; as long as there is no rotational deformity (may have cosmetic deformity but good function). The hand is immobilized in a gutter splint with the MCP joint flexed and IP joint straight until discomfort settles - a week or two - and then the hand is mobilized. The little and ring fingers are buddy-taped to prevent malrotation.

Operative treatment: 
If the fracture needs reduction, this can be done under a local block. The reduced finger is immobilized using the same technique as above.

Barton's fracture is the intra-articular fracture of distal radius resulting from shearing force. It can be classified as dorsal or volar depending upon location of fragment. The diagnosis can be made by clinical presentation and radiologic evidence. The fracture is treated by closed reduction and the forearm is immobilized in a cast for 6 weeks. Open reduction and Internal fixation is required in those cases where closed reduction fails.

Fractures of the ankle involve ipsilateral ligamentous tears or bony avulsion and contralateral shear fractures. The pattern of  fracture is determined by the mechanism of injury. Avulsion fractures are transverse and shear fractures are oblique (if pure inversion/eversion) or spiral (if rotational).

The X-ray above shows ankle joint of right lower limb. An avulsion (transverse) fracture can be appreciated on the lateral malleolus and a shear (oblique) fracture can be seen on the medial malleolus. This is a Danis-weber Type A (infra-syndesmotic) ankle fracture which occurs as a pure inversion injury (Supination-adduction according to Lauge Hansen classification). The avulsion of lateral malleolus is below the plafond. Open reduction and Internal fixation (ORIF) is recommended for Bimalleolar fractures.