What is a wrist fracture?
When a doctor tells you, “You broke your wrist”, he might mean several things, depending on how he defines the term wrist. This article will summarize the anatomy of the wrist and describe the most common type of broken wrist and its treatment.
Hand and wrist surgeons define the wrist as the carpal bones that exist between the end of your forearm (radius and ulna bones, where they meet near the hand) and the actual hand bones, or metacarpals.
Bone is made up of layers – cortical, cancellous bone, and marrow.
The wrist joint that most people (and most doctors) think of when referring to “the wrist” is formed at the junction of the radius and ulna and the eight small carpal bones.
These bones are attached to each other by strong ligaments (which join bones to other bones) and move smoothly against each other to allow all the flexible motions of the wrist.
The most common wrist fracture
The most commonly fractured (same as a break) bone in the wrist is the radius bone. Technically, as I mentioned above, the radius is a forearm bone.
The most common way the radius is fractured is when patients trip and fall and use their hand to break their fall. In these situations, the hand and wrist are preventing a more severe injury to the head, face, or neck.
Other injuries to the wrist can happen during a fall – click here to read an article that may help you decide if you’ve had a sprain or a fracture.
How do doctors evaluate wrist fractures?
Most patients wind up visiting their regular doctor or the emergency room after a fall where they suspect a bad wrist injury. Depending on how bad the initial x-rays are, that doctor may send you to an orthopaedic specialist or hand surgeon for more a more detailed evaluation.
A surgeon may use several words to describe your fracture after getting special x-ray views of the wrist.
Some words doctors use to describe radius fractures are as follows:
- complete (bone broken all the way through)
- incomplete (cracked or broken part of the way through)
- compound (an old term that just means the bone came through the skin – most wrist surgeons use the term “open” now)
- intra-articular (through the joint – may increase chances for arthritis)
- greenstick (an incomplete fracture common in children)
- displaced (pieces moved out of the right position)
How are fractures of the wrist treated?
The appropriate treatment of a radius fracture at the wrist level can be very complex. Some general guidelines are as follows:
- The more the fracture is displaced or bent, the greater the need for surgery
- The more smashed or shattered the joint is, the greater the need for surgery
Non-fracture factors to consider when treating wrist fractures
The following factors must always be considered when deciding whether or not to have surgery for a broken radius:
- activity level (do you sit all day watching TV or are you an active athlete?)
- occupation (are you lifting cinder blocks or sitting at a desk?)
- prior injuries
- hand dominance (are you right or left handed?)
The stability of a radius fracture
The stability of a fracture refers to the likelihood that the fracture alignment will get worse or stay the same over the next few weeks after injury. A stable fracture isn’t likely to move or get worse in a cast. An unstable fracture has a high chance of getting worse and causing functional problems in the future.
In most cases, unstable fractures should be fixed in surgery.
Cast and splint treatment for radius fractures
Your surgeon may put you in a cast (hard cast all the way around your wrist) or a splint (slab of plaster or fiberglass on the palm side of the wrist, held on with an ace wrap and padding) to protect the fracture while it heals.
Casts and splints may need to be long (up the entire arm; above the elbow) or short (stopping just below the elbow), depending on where the fracture is.
Wrist fractures and surgical treatment
Many methods and techniques exist for fixing broken wrists with metal hardware. Usually this involves putting a plate and screws on the bone to hold it in place. Modern hardware has advanced to the point where some early motion and light use is possible soon after surgery.
Other techniques include putting pins through the skin and into the bone to keep it in place, or putting an external frame across the wrist to keep the bones from moving.
How long does it take for a wrist fracture to heal?
Fractures in adults generally take six weeks to heal. After six weeks, there is usually a fair amount of stiffness that needs to be worked out before unrestricted use is possible. Usually you can do this at home, but you may need two or three visits with a therapist to get you started.
Will my wrist function normally after treatment?
This depends on many factors. Severity of the fracture is probably the most important one. The worse the fracture is, the more problems you’ll have with the wrist in the future.
100% normal function is usually not possible (in the same way that nothing is guaranteed), but pain-free function that doesn’t limit what you want to do is attainable in most situations.
Full recovery may take several months, and some patients may have some leftover stiffness or aching, especially with weather changes. Most patients with stiffness and limited motion can make dramatic improvements with the help of physical or occupational hand and wrist therapy.
Wrist fracture videos (WARNING: the second one is pretty graphic!)
cast image: http://www.flickr.com/photos/daveparker/