Wrist Fracture
A wrist fracture is a medical term for a broken wrist. The wrist is made up of eight small bones which connect with the two long forearm bones called the radius and ulna. Although a broken wrist can happen in any of these 10 bones, by far the most common bone to break is the radius. This is called a distal radius fracture by hand surgeons (Figure 1).
“Non-displaced” breaks are fractures in which the bones crack but do not move out of place. “Displaced” breaks are fractures in which the bones are shifted out of place. Fractures can also be classified into stable and unstable. In stable fractures, the bone tends to stay and not keep moving out of place. In unstable fractures, the bone pieces tend to move or shift into a bad position before they solidly heal. This can make the wrist appear crooked.
Some fractures are more severe than others. Fractures that break apart the smooth joint surface or fractures that shatter into many pieces (comminuted fractures) may make the bone unstable. These severe types of fractures often require surgery to move the pieces into the right location and hold their alignment. An open fracture, commonly known as a “compound” fracture, occurs when a fragment of bone breaks and is forced out through the skin. This can cause an increased risk of infection in the bone.
Causes
A wrist fracture occurs from an injury such as falling down onto an outstretched hand. Severe trauma such as car accidents, motorcycle accidents or falls from a ladder cause more severe fractures. Weak bones (for example, in osteoporosis) tend to break more easily.
Signs and Symptoms
When the wrist is broken, there is usually pain and swelling. It can be hard to move or use the hand and wrist. Some people can still move or use the hand or wrist even if there is a broken bone. Swelling from a fracture or a bone out of place can make the wrist appear deformed. There is often pain right around the break and with finger movement. Sometimes the fingers tingle or feel numb at the tips.
It is important that you seek care right away if you think you have experienced a wrist fracture. This is especially true if you see bleeding, have numbness or tingling, have deformity of the wrist or hand, or have severe pain.
Diagnosis
Your hand surgeon will do a physical examination and obtain x-rays to see if there is a broken bone. Tests such as a CT or MRI may be needed to get better detail of the fracture fragments and other injuries. Some fractures do not show up or are not easy to see on the first x-rays, but because of the way the body heals, may become more obvious on x-rays after a bit of time. Your hand surgeon may recommend getting another set of x-rays shortly after. Ligaments, tendons, muscles and nerves may also be injured when the wrist is broken. These injuries may need to be treated also.
Treatment
Treatment depends on many factors, including:
- Type and severity of fracture, for example, if it is displaced, unstable or open
- Your age, job, hobbies, activity level, and whether it is your dominant hand
- Your overall general health
- Presence of other injuries
If you think that you have experienced a wrist fracture, calling your hand surgeon is a good first step. They can direct you to the appropriate treatment facility, which may be an urgent care or emergency room. If you think that the fracture is severe, consider going to your local emergency department.
For stable fractures, a padded splint or cast may be all that is necessary to allow the bones to heal in position. Sometimes, the bones are “set” or “reduced” after numbing the area with a local anesthetic such as lidocaine, or by numbing the entire arm with a “nerve block.” A light sedation may be used to relax your muscles to allow for the treatment team to put the fracture back in place more safely. Other fractures may benefit from surgery to put the broken bones back together and hold them in correct place while healing of the bone occurs.
Fractures may be fixed with many devices or implants in surgery if your hand surgeon decides with you that surgery is the best option. Pins, screws, plates, rods or external fixation (pins and bars outside the skin) can all be used (Figure 2). A small camera might be used to help visualize the joint from the inside. Sometimes the bone is so severely crushed that there is a gap in the bone once it has been realigned. In these cases, a bone graft may be added to help the healing process. Your hand surgeon will discuss the options that are best for your healing and recovery.
Recovery
No matter the treatment option selected, it is very important to keep your fingers moving to keep them from getting stiff and to keep your wrist elevated above the level of your heart. Swelling is a major cause of pain and slower return of function and moving the fingers and keeping the wrist elevated lowers swelling. Your hand surgeon will have you start moving your wrist at the right time for your fracture. Hand therapy is often helpful to recover motion, strength and function.
Recovery time varies and depends on a lot of factors. It is not unusual for recovery to take months. Even then, some patients may have stiffness or aching. Severe wrist fractures can result in arthritis in the joint. Occasionally, additional treatment or surgery is needed based on how the wrist heals.
Therapy
Often, hand therapy is recommended following a wrist fracture. If recommended by your hand surgeon, it is very important to keepingfingers mobile while in your splint or cast.In many cases, patients are told to “move” the fingers, but not “use” the hand. Hand therapists can help with this direction.Limiting the stiffness and swelling in the fingers helps overall recovery time and outcome.
Depending on the specific needs of the patient, therapy can includerange of motion, strengthening, activity progression, and dynamic tasks to allow maximal return of use of the involved extremity.It is also important to keep motion in proximal structures, including the elbow and shoulder.
© 2023 American Society for Surgery of the Hand
This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand.Find a hand surgeon near you.