At the Hand Center of Louisiana, we often treat patients who have experienced a wrist fracture. One of the most common hand and upper extremity injuries, a wrist fracture can severely impact quality of life by making it difficult to perform routine activities, hobbies, professional responsibilities, and other tasks. It can also pose long-term consequences or complications if not addressed in a timely manner. For these reasons, understanding the nature of this injury and its treatment can help you decide if need to contact an orthopaedic surgeon for evaluation.
What is a wrist fracture?
A wrist fracture, also known as a broken wrist, occurs when a break or crack occurs in one of the bones forming the wrist. Comprised of 8 small bones, the wrist is also supported by two long forearm bones called the radius and ulna. While a wrist fracture can occur in any of these 10 bones, the most common injury occurs when the radius breaks or cracks, a condition called a distal radius fracture.
The severity of wrist fractures varies by case. Severe wrist fractures may result in bone instability by breaking the smooth joint of the wrist or shattering any bone into many pieces (comminuted fractures). These severe cases often require hand surgery to repair the injury. Another severe case occurs when a fragment of broken bone breaks the skin (known as a compound or open fracture), which increases the likelihood of infection. The alignment of the bones once healed may affect the wrist’s function. If the bones heal in a significantly altered position, there may be permanent limitations in motion with an increased risk of arthritis and pain.
Wrist Fracture Symptoms
Pain and swelling accompany a wrist fracture, which may make it difficult to move the wrist or hand. The source of pain often occurs near the break and with finger movement. In certain cases, the fingertips may experience tingling or numbness, which often indicates nerve injury. Additionally, swelling or displaced bone may make the wrist appear deformed.
Common Causes of Wrist Fractures
Common causes of a wrist fracture include the following:
A wrist fracture may occur when enough force is applied to the wrist, such as when falling down onto an outstretched hand. Severe injuries may occur from a more forceful injury, such as car or motorcycle accidents, or a fall from a roof or ladder. Osteoporosis, a common condition that weakens the bone by making it thinner or more brittle, may make a person more susceptible to experiencing a wrist fracture with a simple fall.
How Fractures Are Evaluated
Examination and X-rays are needed so that your doctor can tell if there is a fracture and assess the position of the bones, in order to help determine the treatment. Occasionally a CT scan may be helpful to get better detail of the fracture fragments. In addition to the bone, ligaments (the structures that hold the bones together), tendons, muscles, and nerves may be injured as well when the wrist is broken. Ligament injuries, tendon injuries, muscle injuries, and nerve injuries may need to be treated in addition to the fracture. Whenever the bone protrudes through the skin, it is important to receive immediate care to minimize the risk of bone infection.
How Wrist Fractures Are Treated
Treatment, whether nonsurgical or surgical, depends on numerous factors including:
- Type and severity of fracture (displaced, unstable, open/compound)
- Age, activity level, hobbies, occupation, hand dominance
- Health status (prior injuries, wrist arthritis, or other medical problems)
- Bone density (e.g., existence of osteoporosis)
Your physician may recommend one or more of the following nonsurgical treatment options:
- Immobilization with cast or splint
- Medication therapy
To ensure proper healing, your orthopaedic surgeon may recommend the use of a splint or cast to restrict displacement (movement) or the broken wrist bone. Usually, a cast is worn for several weeks depending on the severity of the fracture and the body’s ability to heal the broken bone. Your surgeon will also recommend raising your hand above heart level as much as possible to reduce swelling and pain in your hand and wrist.
Wrist fractures may also be treated through medications. Your hand surgeon may recommend the use of an over-the-counter pain reliever, such as nonsteroidal anti-inflammatory (NSAID) medication, to reduce pain. Depending on the severity of your pain, you may be prescribed an opioid medication, such as codeine, to alleviate pain symptoms. Use of NSAIDs, especially regularly over a long period, may delay or prevent bone healing. Consult with your surgeon about taking pain relievers before using them.
If your fracture is open (compound), your physician may prescribe an antibiotic to prevent an infection that could reach the bone.
Once the wrist fracture gains enough stability, your hand surgeon may recommend hand therapy to enhance the recovery process, reduce stiffness, and restore movement. The timing of therapy depends and may accompany the removal of a cast or splint. Therapy, once it commences, may take several weeks or months depending on the severity of the injury.
Surgical and other procedures
You may need surgery depending on the severity and type of your wrist fracture. Surgery may be necessary in the following situations:
- Bone misalignment
- Bone movement (displacement) before healing
- Missing or crushed bone resulting in a gap after realignment
- Nerve injuries, tendon injuries, damage to surrounding ligaments, or damage to blood vessels
If the broken ends of the bone are not aligned, you may need a procedure known as reduction, in which your hand surgeon manipulates pieces of bone or fragments back into position to eliminate gaps or avoid overlapping.
Bone displacement may call for the use of pins, screws, plates, rods, or external fixation. Your hand surgeon can place plates and screws through an incision on the top or bottom of the wrist, which hold the bone fragments in place and may allow early use of the hand and wrist. These implants are buried inside the wrist and usually do not require removal.
External fixation is a method that uses implants and a metal frame to stabilize the bone until it heals. Pins are implanted above and below the fracture site and are attached to the frame outside the body.
Sometimes, a missing or crushed bone results in a gap after bone realignment. In this case, a bone graft may be necessary. In this procedure, bone is taken from another part of the body or a bone bank, or bone graft substitutes are used, to fill the defect.
The Prognosis For Wrist Fractures
Recovery time varies considerably, depending on the severity of the injury, associated injuries, and other factors as noted previously. It is not unusual for maximal recovery from a wrist fracture to take several months. Some patients may have residual stiffness or aching. If the surface of the joint was badly injured, arthritis may develop. On occasion, additional treatment or reconstructive surgery may be needed.
Relieve Your Wrist Pain
A wrist fracture can diminish your quality of life and prevent you from performing important tasks, hobbies, and more. The condition poses long-term consequences if not treated promptly, including arthritis and deformity, emphasizing the need for timely evaluation and treatment. If you believe you have this injury and would like to be evaluated, we encourage you to contact us using the form below. As the largest hand and upper extremity practice in the Gulf South region, we provide fully integrated care, including evaluation and treatment by our team of highly experienced physicians; onsite diagnostics including X-ray, CT scan, fluoroscopy, and more; and physical and occupational therapy.