WRIST FRACTURES

The wrist is made up of eight small bones which connect with the two long forearm bones called the radius and ulna. A broken wrist can happen in any of these 10 bones, but the most common bone to break is the radius. This is called a distal radius fracture or “Colles’ fracture” by doctors.

Some wrist fractures are “stable” where the bones maintain their place as they heal. These can be treated with a cast.  If the broken parts shift out of alignment, using local or general anaesthesia, the fracture has to be “reduced” or set into place before application of a cast. The position of the fracture is closely watched by x-rays every few weeks to ensure that alignment is not lost in the cast.

Some fracture patterns are “unstable”, that is, the fragments will likely shift even if a cast is applied. These fractures require fixation by surgery using wires or plates and screws to hold the bone aligned while it heals.

CAUSES

A wrist fracture occurs from an injury such as falling down onto an outstretched hand such as a trip and fall or fall during sport, from a bicycle or skateboard. Since we usually put our hands out in front as we fall, wrist fractures are the most common fractures seen in the emergency room and affect all ages.

Severe trauma such as car accidents, motorcycle accidents or falls from a ladder cause more serious injuries with open injuries where the bone comes out through the skin.

SYMPTOMS

When the wrist is broken, there is pain and swelling with immediate bruising of the area. It can be hard to move or use the hand and wrist. Swelling or a bone out of place can make the wrist appear deformed. If the swelling is severe, pressure on the nerves may result in tingling or numbness of the fingers.

DIAGNOSIS

Your hand surgeon will perform 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 if x-rays are doubtful or to get better detail of the fracture fragments and other injuries. Ligaments, tendons, muscles and nerves may also be injured when the wrist is broken and may need to be treated.

TREATMENT

Initial treatment in the emergency room often consists of improving alignment and applying a splint for comfort. Subsequent treatment is planned in discussion with a hand surgeon and takes into account issues such as type of fracture, age, job, hobbies, activity level and other injuries.

Fractures may be fixed with many devices such as pins, rods or plates and screws. Your hand surgeon will discuss the options that are best for you.   

Non-operative treatment usually involves immobilisation in a cast for up to 6 weeks followed by rehabilitation. Following surgery, movement may be allowed as soon as 1-2 weeks and rehabilitation and recovery may be a little quicker.

RECOVERY

During recovery it is very important to keep your fingers moving to keep them from getting stiff. Hand therapy is often prescribed to assist in rehabilitation.

Recovery time varies with the severity of the injury and if complications develop during treatment. Even with simple fractures, it is not unusual for recovery to take 3 months or longer. Some patients may have stiffness or aching that may persist. Severe wrist fractures can result in arthritis in the joint. Occasionally, additional treatment or surgery is needed if the fracture does not heal properly.