The wrist is composed of eight small bones and two forearm bones, the Radius and Ulna. The shape of the bones allows the wrist to bend and straighten in an upward or downward direction in the palm, as well as move and rotate side to side. Fractures in any of these bones can occur if enough force is applied, such as during a fall with an open hand or during high-energy impacts like a car accident or falling from a high place like a roof.
Bone loss or osteoporosis, a common condition where bones become more fragile, can make patients more prone to wrist fractures.
The most commonly broken bone in the wrist is the Radius. Many people think of fractures and breaks as being different, but they are the same thing. When the wrist is broken, there is pain, swelling, difficulty using the hand and wrist. Deformity or misalignment of the wrist is often visible.
In fractures of small wrist bones like the scaphoid, there is no deformity in the hand. In simple fractures, the bone fragments have not moved and remain aligned. In displaced fractures, the bone fragments are unbalanced and have a tendency to either pop out of place or shift, increasing the likelihood of deformity in the wrist. Some fractures can result in a break in the joint. Sometimes, the bone fragments into many pieces, which can make it unbalanced. An open fracture occurs when a piece of bone protrudes through the skin (outward from the inside) or when skin is penetrated by a hard object (inward from the outside).
How is a Wrist Fracture Evaluated?
A physical examination and X-ray imaging are required for your doctor to determine if there is a fracture and to assist in determining the treatment. In some cases, a CT scan or MRI imaging may be used to obtain better details of the fracture and any associated injuries. When the wrist is fractured, bones, ligaments (structures that hold bones together), tendons, muscles, and nerves can also be injured. These injuries may need to be treated along with the fracture treatment.
How are Wrist Fractures Treated?
The structure of the fracture, whether it is displaced or not and if it is prone to displacement, are factors that determine the treatment. Other important factors include age, overall health status, if the fracture is in the dominant hand, work and hobby activities, prior injury or joint cartilage disorder (arthritis), and related injuries.
Treatment of Wrist Fractures with Cast
If the fracture is not displaced, a simple two-part fracture and has no or very little displacement potential, the fracture is treated by being fixed with a cast. It usually stays in the cast for 4-6 weeks.
The course of action to be followed in the treatment of displaced fractures is as follows.
Under anesthesia so the patient does not feel pain, the fracture is corrected (reduced) and controlled under the mobile X-ray device (scope) in the operating room conditions.
The fracture is stabilized and a cast is made in the appropriate position after the correction is made and the image is taken under the scope.
If the correction is made and displacement is observed during the testing stage, the fracture is stabilized with 3-4 external K wires before open surgery.
If enough correction cannot be achieved, the fracture is corrected with open surgery and secured with metal plates and screws, and sometimes with metal wires from the outside.
What Materials are Used in Wrist Surgery?
Fractures are stabilized with K-wires, screws, plates, rods, or external fixation. External fixation is a method in which a frame outside the body is attached to the fracture site with wires placed above and below the bone and actually stabilizes it from the outside until the bone heals.
Sometimes the bone may be missing or severely crushed so that it will create a gap when aligned. In such cases, a bone graft (graft) may be necessary. In this procedure, a bone from another part of the body is taken to fill the missing bone part. Another method is to fill the bone void with a bone from a bone bank (allograft) or a synthetic bone graft.
Keeping the fingers moving is very important during the healing of the wrist fracture, provided that there is no other injury that will require the fingers to remain motionless. Otherwise, the fingers will stiffen and hinder the improvement of hand function.
Once the wrist has sufficient stability with surgery, movement exercises for the wrist can be started. Usually, wrist exercises are started about 1 week to 10 days after surgery, and the patient is closely followed. Therapy is used to help improve flexibility, strength, and function.
