What Is a Wrist Fracture?
The wrist is made up of eight small bones and the two forearm bones, the radius and ulna. The shape of the bones allows the wrist to bend and straighten, move side-to-side, and rotate, as in twisting the palm up or down. A fracture may occur in any of these bones when enough force is applied, such as falling onto an outstretched hand. Severe injuries may occur from a more forceful injury, such as a car accident or falling off a roof or ladder. Osteoporosis, a common condition in which the bone becomes more brittle, may make one more susceptible to a wrist fracture.
The most commonly broken bone of the wrist is the radius. Many people think a fracture is different from a break, but they are the same. When the wrist is broken, there is pain, swelling, and decreased hand and wrist use. Often, the wrist appears crooked and deformed. Fractures of the small wrist bones, such as the scaphoid, are unlikely to appear deformed. Fractures may be simple with the bone pieces aligned and stable. Other fractures are unstable, and the bone fragments tend to displace or shift, making the wrist more likely to appear crooked. Some fractures break the usually smooth, ball-bearing-like joint surface; others will be near the joint but leave the joint surface intact. Sometimes, the bone is shattered into many pieces, making it unstable. An open (compound) fracture occurs when a bone fragment breaks through the skin. There is some risk of infection with compound fractures.
Diagnosis
Examination and X-rays are needed so your doctor can tell if there is a fracture and help determine the treatment. Sometimes, a CT scan or MRI may be used to get better details of the fracture fragments and associated injuries. In addition to the bone, ligaments (the structures 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 in addition to the fracture.
Treatment
The pattern of the fracture, whether it is displaced or non-displaced, and whether it is stable or unstable are all factors in determining the treatment. Other important considerations include age, overall health, hand dominance, work and leisure activities, any prior injury or arthritis, and any associated injuries.
A splint or cast may be used to treat a fracture that is not displaced or to protect a fracture that has been set. Other fractures may need surgery to properly set the bone and/or to stabilize it. Fractures may be stabilized with pins, screws, plates, rods, or external fixation. External fixation is a method in which a frame outside the body is attached to pins placed in the bone above and below the fracture site, keeping it in traction until the bone heals. Sometimes, arthroscopy is used in the evaluation and treatment of wrist fractures. Your hand surgeon will determine the most appropriate treatment for your case.
On occasion, bone may be missing or may be so severely crushed that there is a gap in the bone once it has been re-aligned. In such cases, a bone graft may be necessary. In this procedure, bone is taken from another part of the body to help fill in the defect. Bone from a bone bank or synthetic bone graft substitutes may also be used.
While the wrist fracture is healing, it is very important to keep the fingers flexible, provided that no other injuries would require the fingers to be immobilized. Otherwise, the fingers will become stiff, hindering the recovery of hand function. Once the wrist has enough stability, motion exercises may be started for the wrist itself. Your hand surgeon will determine the appropriate timing for these exercises. Hand therapy is often used to help recover flexibility, strength, and function.
Recovery time varies considerably, depending on the severity of the injury, associated injuries, and other factors, as noted previously. It is not unusual for maximal recovery from a wrist fracture to take several months. Some patients may have residual stiffness or aching. If the surface of the joint is badly injured, arthritis may develop. On occasion, additional treatment or reconstructive surgery may be needed.