Wrist Fracture
What is a Wrist Fracture?
Wrist fracture is one of the most common injuries seen in emergency settings each year. Unlike other types of injuries, they are common to all age groups. Wrist fractures in children occur during sports or physical activities, but low impact fractures from falls are more common in the elderly.
Motor vehicle accidents are another leading cause of this type of injury. Because the wrist is important for variety of hand and arm movements, such injuries can create significant disability. Wrist fractures are usually treated initially by an orthopedist.
Learn about different types of wrist fractures, treatment plans & best doctors for treating wrist fracture injuries & pain. We have a great list of doctors & specialists near you for treating wrist injuries caused by an accident.
Anatomy of the Wrist
The wrist consists of 10 bones which collectively enable 360-degree movement of the hand and twisting of the forearm. It includes a cluster of eight, pebble-like bones at the base of the hand, and the distal ends of the two forearm bones. The bones of the forearm are called the ulna and radius.
The radius is on the thumb side of the wrist, and the ulna is on the side of the fifth finger. These bones are encased within ligaments that hold them in place, forming the carpal tunnel. Blood vessels, nerves, and tendons run through the carpal tunnel and into the hand. The commonly known term carpal tunnel syndrome refers to pain in this area.
Types of Wrist Fractures
All wrist fractures are associated with pain, bruising, and swelling. They are often obvious due to deformity of the wrist. The distal radius is the most frequently affected bone, but other wrist bone fractures are possible.
High velocity injuries can cause the fractured bone to pierce through the skin. This is called a compound fracture. Comminuted fractures, or crushed bone pieces, are often sustained in car accidents. Bones weakened by osteoporosis are more prone to these fractures.
Distal Radius Wrist Fracture
This type of wrist fracture is found near the base of the thumb. The break occurs at the radial neck, where the narrow portion of the radius meets its flared end. The radius may be crushed or displaced depending on the type of impact. For example, it is a protective reflex to extend the arms during a fall, and to land on outstretched hands.
Unfortunately, this causes the most common type of distal radius injury, a Colles fracture. A Smith’s fracture occurs similarly, but with the hands flexed downward. This type of fall puts force on the back of the hand, causing a break at the radial neck. The very tip of the radius, the styloid, is a particularly fragile area. This segment breaks off, creating a floating bone fragment. Also known as a Chauffeur’s fracture, styloid fractures are due to injury to the back of the hand or wrist.
Distal Ulna Fractured Wrist
Solitary fractures of the distal ulna are possible, but they typically occur in conjunction with radius fractures. Similar to the latter, the break occurs at the neck of the ulna. The ulna also has a styloid segment that is prone to fractures.
Small Bone Wrist Fractures
Because of its proximity to the distal radius, the scaphoid bone is the most common small wrist bone injury. It may be displaced or fractured during a fall onto an outstretched hand. A scaphoid fracture is particularly concerning because its unique blood vessel location may be compromised. If so, this bone may fail to heal properly.
Triquetrum fractures may occur along with those of the ulna styloid during outstretched hand injuries. The trapezium sits at the base of the index finger bones and is fractured during hyperextension injuries. Hamate fractures are rare, and are primarily sustained while playing sports.
Wrist Fracture Treatment Options
Decisions about treatment are determined by the number of wrist bones involved, and the severity of the fractures. It is usually best to see an orthopedist if a wrist fracture is suspected. X-rays, CT scans, and MRIs provide valuable information. Many simple fractures can be managed without surgery, particularly if the bone displacement is minimal. Compound and comminuted fractures require surgery.
Closed Reduction Wrist Treatment
For simple radius or ulna fractures, a closed reduction technique may be performed in an emergency room or the office of an orthopedist. Intravenous sedation and pain medication may be necessary for the procedure to be successful.
A local anesthetic is injected into the collection of blood at the fractured bone. Once the area is appropriately anesthetized, traction is applied to the hand, distal to the fracture, while the displaced bone is maneuvered into place. This reduction may be done with the assistance of fluoroscopy. If not, proper bone alignment is confirmed with an x-ray following the procedure.
Once the fracture is reduced, the wrist is stabilized within a splint. This allows any swelling to resolve before the placement of a cast two weeks later. Care is taken to avoid constriction of the carpal tunnel nerves, and to maintain adequate blood flow to the fingers. Pain medication is often prescribed during this time. The wist will remain in a cast for six weeks, and bone healing is monitored with x-rays.
External Fixation Wrist Fracture Treatment
External fixation is a wrist stabilizing technique that involves placing pins through the skin, into the affected bones, then attaching a metal rod outside of the skin. Fluoroscopy is used to confirm both fracture reduction and placement of the hardware.
The external hardware is kept in place for 8 weeks, after which it is removed. This technique avoids the need for a cast and allows for better finger and forearm muscle movement. This option has a lower risk of infection than internal fixation and is particularly ideal for individuals with medical conditions that impair healing.
Open Reduction Internal Fixation Treatment
For more complicated fractures or those that align poorly with closed reduction, surgical options are considered. During surgery, the fractures and bone fragments are directly visualized and re-aligned.
Pins, bone screws, and metal plates may be used to reconnect the bones depending on the type of injury. General anesthesia is used for open reductions, and a short hospital stay may be necessary.
This technique is used when all other options would fail to promote the best outcome. During this procedure, the fracture is reduced, but the metal pins, rods, or plates are surgically implanted. For example, a distal radius fracture may be secured using a metal plate to hold the displaced bone and radial neck in place.
Alternatively, the distal and mid-radius can be stabilized by using screws and a forearm rod. Internal fixation hardware is left in place permanently unless a situation arises that warrants its removal. Post-operatively, the wrist is placed in a splint for two weeks, followed by a cast for six additional weeks.
Overall, internal fixation is well tolerated. Some studies indicate that outcomes of distal radius fractures are better when this treatment option is employed instead of a closed reduction. Because it is a more invasive procedure, however, there is a higher risk of post-operative infection. Muscles near metal plates may become inflamed, and there have been rare cases of tendon rupture.
Wrist Fracture Recovery
A period of rehabilitation is always necessary to regain full use of the wrist. Some initial muscle and tendon stiffness is expected, and temporary wrist or hand numbness is possible. Physical therapy, therefore, is essential to a good recovery. Once a fracture heals from a closed reduction, physical therapy helps build wrist mobility and forearm muscle strength.
The recovery time is much longer for open reduction procedures. Depending on the severity of the injury or type of surgery, full use of the wrist may take up to a year. Hand physical therapy is recommenced within a week of the external fixation to maintain finger flexibility.
Once the external hardware is removed following an external fixation, more intensive occupational and physical therapy helps to achieve as much mobility as possible. When internal fixation is performed, simple finger exercises may be recommenced during the first post-operative week. By the second week, light wrist exercises are encouraged.
Once the fractures have fully healed, more intensive physical and occupational therapy must be part of the rehabilitation plan.
