Wrist Fractures - What you need to know

Wrist fractures may happen in a simple incident like falling down in a bad way, or in more severe ones like a vehicle accident, in which hand and other injuries may also be present. Either way, wrist fractures need to be treated by a wrist specialist as early as possible to minimize the likelihood of any permanent disabilities.

In this article, we share with you what you need to know about Wrist fractures.

Table of contents:

1. Understanding the Wrist
2. Understanding a Wrist Fracture
3. How Elbow Injuries occur
4. Diagnosis and Treatment Options
5. Conclusion

 

 

Understanding the Wrist

The wrist consists of eight small carpal bones and the end of our two forearm bones; the radius and ulna

 The unique arrangement of these bones permits the wrist to move in different directions, including bending, straightening, rotating, and moving from side to side.

Understanding a Wrist Fracture

Fractures of the wrist frequently occur because of a fall on an outstretched hand although other mechanisms may cause fractures as well. The more violent the injury, the more severe the fracture is likely to be. Elderly who may suffer from osteoporosis may have more brittle bones, increasing the risk of a wrist fracture from a fall.

The most common wrist fracture occurs at the end of the radius and is medically termed a distal radius fracture (Figure 2). The presence of a break in the bone, whether it is a hairline crack or if the break is obviously displaced constitutes a fracture. All fractures are associated with pain and swelling, but other symptoms include:

• Tenderness on the wrist
• Joint deformity

 

The presence of visible deformity or crookedness indicates significant displacement of the fracture. Occasionally, there may be an open wound over the wrist and sometimes there may be numbness in the fingers. This indicates the presence of an open fracture and median nerve compression correspondingly and requires immediate attention.

Fractures of the distal radius vary. Some fractures may be grossly mal-aligned and comminuted (shattered) whilst some may only be slightly displaced. Approximately half of all distal radius fractures will extend to involve the joint surface and may impact subsequent joint motion if not appropriately treated.

Diagnosis and Treatment options

The hand surgeon will examine the wrist and order X-rays to diagnose and characterize the fracture. Sometimes advanced imaging techniques such as CT scans and MRIs are required after the x-rays for more complex fractures and when associated soft tissue injury (ligaments, tendons, and muscles) is suspected. Associated injuries may require treatment as well.

Two factors are weighed when treatment is planned. Whether a fracture is displaced or undisplaced, as well as fracture stability and severity form the first set of considerations. Patient factors form the second set of considerations. Your age, hand dominance, vocational as well as leisure activities and expectations of functional recovery are important, and the hand surgeon will work closely with you towards achieving your desired recovery goals.

 

Fractures that are not displaced or minimally displaced may be adequately treated with a cast or splint (Figure 3). Fractures that remain stable after closed manipulation and reduction may also be treated this way.

Fractures that are unstable, irreducible, displaced, comminuted and extending to the joint may be more appropriately addressed with surgery. This involves setting the fracture in proper alignment and most frequently, maintaining the alignment with a low-profile plate and screws, which are minimally invasive (Figure 4).

 

Once the fracture has healed with sufficient stability, formal hand therapy rehabilitation may be initiated. This typically commences 4-6 weeks after cast or splint immobilization and a few days after surgery.

What kind of results to expect

Results vary according to the type of fracture as well as the type of treatment. Fractures that are treated surgically typically make maximal recovery between 3-6 months whilst that treated non-surgically may take twice as long.

Sometimes, associated injuries or severe joint surface injuries will limit the final functional recovery possible. This may manifest as residual stiffness, aching and sometimes pain. With a collective experience of more than two decades of treating these injuries, our hand surgeons can give you the best advice on how to manage your wrist fracture and wrist pain.

Conclusion

Wrist fractures are extremely painful and greatly affects your ability to move your hand around freely. Seek immediate medical advice from a wrist specialist like us, and we'll help you to diagnose and recommend the right treatment for your hand and wrist injuries, such as:

• Carpal tunnel syndrome
• De Quervain's tenosynovitis (tendon pain on thumb side of the wrist)
• Trigger finger (one finger stuck in bent position)