Wrist Fracture

Distal radius fractures usually occurs after a fall on an outstretched hand. It can also happen in a car accident, a bike accident, a skiing accident, and similar situations. Distal radius fractures are very common. The radius is the most commonly broken bone in the arm.

Sometimes, the ulna is also broken. When this happens, there is an associated distal ulna fracture.

A broken wrist usually causes immediate pain, tenderness, bruising, and swelling. Frequently, the wrist hangs in an odd or bent way (deformity).

Diagnosis is confirmed by X-ray of the wrist. This is important to understand the extent of the injury. Although the fracture almost always occurs about 1 inch from the end of the bone, there are a number of sub-classifications which are important to differentiate.

A fracture that extends into the joint, is called an intra-articular fracture. A fracture that does not extend into the joint is called an extra-articular fracture. When a fractured bone breaks the skin, it is called an open fracture and when a bone is broken into more than two pieces, it is called a comminuted fracture.

It is important to classify the type of fracture, because some fractures are more difficult to treat than others. Intra-articular fractures (fractures within the joints), open fractures (fractures that break through the skin), and comminuted fractures (fracture that shatter the bone into a lot of small pieces) are more difficult to treat than a simple closed fracture.

Osteoporosis (decreased density of the bones) can make a relatively minor fall result in a broken wrist. Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position. Good bone health is important for prevention and wrist guards may have a place in helping prevent some fractures (but not all). Screening for osteoporosis after a wrist fracture should be discussed. In contrast, healthy bones can break if the force of the trauma is severe enough.

Treatment depends on many factors, such as the nature of the fracture, age and activity level of the patient, and the surgeon’s preferences.

If the broken bone is in a good position, a plaster cast may be applied until the bone heals. If the position (alignment) of the bones is not good and likely to limit the future use of the arm, it is necessary to correct the deformity. This realignment procedure is called a reduction. This can sometimes be done without an operation (closed reduction) and sometimes requires an operation (open reduction) (see below).

After the bone is properly aligned, a splint or cast may be placed on your arm. A splint is usually used for the first few days, to allow for a small amount of normal swelling. A cast is usually added a few days to a week or so later, after the swelling goes down. The cast is changed again after two or three weeks as the swelling goes down more and the cast begins to loosen.

Further X-rays may be required particularly if the fracture required reduction or was thought to be unstable. The need for further xrays will be determined by the surgeon.

In general, the cast is removed approximately six weeks after the injury. At this point, physiotherapy will help improve the motion and function of the injured wrist.

Open reduction of the fracture may use a variety of implements for holding the bone in the correct position, including metal pins (usually stainless steel or titanium), a plate and screws, an external fixator (a device for which most of the hardware remains outside of the body), or any combination of these techniques.

Regardless of the treatment required, most fractures hurt moderately for a few days to a couple of weeks. Many patients find that using ice, elevation (holding their arm up above their heart), and simple, non-prescription medications for pain relief (such as paracetamol and ibuprofen) are all that are needed.

Casts and splints must be kept dry. A plastic bag over the arm while showering should help. If the cast does become wet, it will not dry very easily. A hair dryer on the cool setting may be helpful.

Surgical incisions must be kept clean and dry for five days or until the sutures (stitches) are removed, whichever occurs later.

Most patients will be able to resume light activities, such as swimming or exercising the lower body in the gym, within a month or two after the cast is taken off or after within a month or two after surgery. Most patients can resume vigorous physical activities, such as skiing or football, between three and six months after the injury. Almost all patients will have some stiffness in the wrist, which will generally lessen in the month or two after the cast is taken off or after surgery. Improvement will continue for at least two years. Most patients do return to all their former activities.

Recovery can take at least one year. Some pain with vigorous activities may be expected for this length of time. Some residual stiffness or ache is to be expected for two years or possibly permanently, especially for high-energy injuries (such as motorcycle crashes, etc), in patients older than 50 years of age, or in patients who have some osteoarthritis. However, the stiffness is usually minor and may not affect the overall function of the arm.