06 Nov Wrist Fractures
Most wrist fractures involve a fracture of the ends of the forearm bones – called the radius and the ulna. At the wrist the radius is much bigger, and is the most commonly injured of the two bones, although a fracture of both bones is also fairly frequent. The smaller bones between the radius/ulna and the hand can also be broken, but this is much less common.
A broken wrist is a common injury, and most frequently happens in a fall on an outstretched hand. This might be a simple slip outside, or on the sports field. Occasionally this injury is seen after motor vehicle accidents, or workplace accidents.
In older patients, a wrist fracture (often called a Colles fracture) can be a sign of osteoporosis, as it is one of the most common fractures seen in patients with osteoporosis.
This is a complex break of the radius, which is very displaced from it’s original position.
A broken wrist is usually very painful, and all movements of the hand / wrist are difficult. Swelling can occur quickly, and bruising over a few hours, and if the bones are displaced then there can be quite significant deformity visible to the naked eye. In more severe cases the swelling and deformity can affect the nerves, leading to numbness in the hand – this requires early intervention to protect the nerve from permanent damage.
Like many injuries however, a whole spectrum of severity is seen. In lower energy injuries (such as a simple fall from standing height), the bones may break but not move far. This is common in children too. In these cases little or no deformity may be apparent, and swelling can be mild. In higher energy injuries the bony fragments can be desplaced several centimeters from their original place, and at times the skin may be broken as a result – an open fracture. These are more serious injuries.
To diagnose a broken wrist, your doctor will ask you questions about how you injured the area, and will examine your arm and hand. Simple x-rays will almost always show this fracture, but at times a CT scan may help as well. Some fractures (such as scaphoid fractures) are difficult to see on day 1, and occasionally better seen on MRI, but this is only done after a period of a few days or weeks.
The initial management of wrist fractures is pain relief, which involves a combination of some form of splint / plaster to stop it moving, as well as analgesia. A decision then is made regarding whether the fracture requires surgery – this decision depends on many factors, related to the patient’s medical state, the type and extent of fracture seen on xray, whether it is the dominant hand, patient expectations for use of the hand afterwards, occupation, and many other issues.
In general however, simple fracture patterns that are well aligned can be managed with a plaster for 5-6 weeks. More complex fractures typically require surgery.
Surgery is performed under a general anaesthetic, and usually involves a small operation through the front of the wrist. The bony fragments are identified and re-positioned, then held in place using a plate and screws.
There are a number of advantaged to surgery for wrist fractures, but the major one is for fractures where the fragments are widely displaced. However, after surgery patients are typically only in plaster for 10-12 days before mobilising in a removable splint, meaning that return to normal function tends to be quicker after surgery. This typically leads to less stiffness, and often a better long term outcome.
As with all surgery however there are risks, in this case a small risk of infection, nerve injury, or anaesthetic complications.
The fracture shown above has been treated with a plate and screws, with the bone fragments back where they should be.
Rehabilitation / return to function
Once the splint has been removed, the aim for all of these injuries is to regain a normal range of motion at the wrist and hand, and to build up strength again. This can take anywhere from a few weeks to several months, but is usually quicker if guided by a physiotherapist. Most patients can drive within a few days of splint removal, return to work however is entirely dependent on the type of work done.