Wrist Fractures

A wrist fracture is a medical term for a broken wrist. The wrist is made up of eight small bones which connect with the two long forearm bones called the radius and ulna. Although a broken wrist can happen in any of these 10 bones, by far the most common bone to break is the radius. This is called a distal radius fracture by hand surgeons.

Some wrist fractures are stable. “Non-displaced” breaks, in which the bones do not move out of place initially, can be stable. Some “displaced” breaks (which need to be put back into the right place, called “reduction” or “setting”) also can be stable enough to treat in a cast or splint. Other fractures are unstable. In unstable fractures, even if the bones are put back into position and a cast is placed, the bone pieces tend to move or shift into a bad position before they solidly heal. This can make the wrist appear crooked.

Some fractures are more severe than others. Fractures that break apart the smooth joint surface or fractures that shatter into many pieces (comminuted fractures) may make the bone unstable. These severe types of fractures often require surgery to restore and hold their alignment. An open fracture occurs when a fragment of bone breaks and is forced out through the skin. This can cause an increased risk of infection in the bone.

CAUSES

A wrist fracture occurs from an injury such as falling down onto an outstretched hand. Severe trauma such as car accidents, motorcycle accidents or falls from a ladder cause more severe injuries. Weak bones (for example, in osteoporosis) tend to break more easily.

SIGNS AND SYMPTOMS

When the wrist is broken, there is pain and swelling. It can be hard to move or use the hand and wrist. Some people can still move or use the hand or wrist even if there is a broken bone. Swelling or a bone out of place can make the wrist appear deformed. There is often pain right around the break and with finger movement. Sometimes the fingers tingle or feel numb at the tips.

HOW IS THE DIAGNOSIS MADE?

Your hand surgeon will do a physical examination and obtain x-rays to see if there is a broken bone. Sometimes, tests such as a CT scan or MRI scan may be needed to get better detail of the fracture fragments and other injuries. Ligaments (the soft tissues that hold the bones together), tendons, muscles and nerves may also be injured when the wrist is broken. These injuries may need to be treated also.

WHAT IS THE TREATMENT?

Treatment depends on many factors, including:
• Type of fracture, whether it is displaced, unstable or open
• Your age, job, hobbies, activity level, and whether it is your “dominant” hand
• Your overall general health
• Presence of other injuries

A padded splint might be worn at first in order to align the bones and support the wrist to provide some relief from the initial pain. If the fracture is not too unstable, a cast may be used to hold a fracture that has been set. Other fractures may benefit from surgery to put the broken bones back together and hold them in correct place.

Fractures may be fixed with many devices. Pins, screws, plates, rods or external fixation can all be used. A small camera might be used to help visualize the joint from the inside. Sometimes the bone is so severely crushed that there is a gap in the bone once it has been realigned. In these cases, a bone graft may be added to help the healing process. Mr Mason will discuss the options that are best for your healing and recovery.

RECOVERY

During recovery, it is very important to keep your fingers moving to keep them from getting stiff. Your hand surgeon will have you start moving your wrist at the right time for your fracture. Hand therapy is often helpful to recover motion, strength and function.

Recovery time varies and depends on a lot of factors. It is not unusual for recovery to take months. Even then, some patients may have stiffness or aching. Severe wrist fractures can result in arthritis in the joint. Occasionally, additional treatment or surgery is needed.