Wrist Fractures
Wrist Fractures

What are Wrist Fractures?

Wrist fractures occur when one or more of the bones that make up the wrist are broken or cracked, usually from a fall or impact.

Understanding the Structure of the Wrist

The wrist is made up of a large group of bones. It contains eight small bones known as the carpals, as well as the ends of the two bones that make up your forearm - the radius and the ulna - and the lower portion of the five metacarpal bones of the fingers. The carpal bones vary in shape and size. The arrangement of these small bones creates a strong and flexible joint. A wrist fracture can impact any of these bones, but is most common in the scaphoid, named for its boat-like shape, which rests at the base of the thumb.

What can Cause a Wrist Fracture?

A broken wrist usually occurs when there is an impact to the wrist bones. One of the most common causes is landing on an extended hand in an attempt to break or catch a fall. People who play contact sports or sports with a higher risk of falling, such as skateboarding or snowboarding are particularly susceptible, as are people with conditions, such as osteoporosis, which makes the bones more brittle. Fractures also commonly occur in automobile accidents.

How is a Fractured Wrist Diagnosed?

The primary symptoms of a wrist fracture are swelling, bruising, pain or tenderness in the wrist. In extreme cases, the wrist itself may be deformed. An accurate diagnosis requires gathering information from you about how the injury occurred and what you are feeling in the area of the injury, conducting a physical exam of the wrist and taking X-rays. One thing to remember is that being able to move the wrist or hand after an injury does not rule out a broken bone.

Treatment Options

If you suspect you have a wrist fracture, you should try to be evaluated as soon as possible. If you can see your hand surgeon right away, that’s ideal. However, if that’s not possible seeing an orthopedist, visiting our Saturday Orthopedic Walk-in Clinic, or even an urgent care is a good idea. Not only can they diagnose the fracture, but they can immobilize and protect the injury until you can make an appointment to see a hand specialist. Urgent and emergent care should be obtained if there is a deformity to the area, a cut or open wound around the injured area, or if you are experiencing numbness or trouble moving your fingers. An untreated or improperly treated fracture can lead to more serious issues, including loss of grip strength and a decreased range of motion. If left untreated for too long, there is also a risk of a more serious condition known as avascular necrosis. A fracture to the scaphoid bone may interrupt blood supply to the rest of the bone and can increase the risk of osteoarthritis to the wrist.

Treatment is determined by many factors: the location and severity of the fracture, the age of the patient, and their activity level.

Non Surgical

If the fracture is nondisplaced or minimally displaced and does not extend into the wrist joint, as with extra-articular distal radius fractures, it can often be treated non-surgically with the use of a splint or cast to immobilize the break and allow it to heal naturally. This process takes about 4 to 6 weeks with regular X-rays to ensure that the bones are healing properly.

Surgical

When a fracture is more serious, or in the smaller bones of the wrist, surgery is often recommended to correct it. There are various types of surgery depending on the area and extent of the injury.

  • Open Surgery

    Open Surgery is usually required for fractures where the bones are displaced or unstable. The surgeon uses a metal plate and screws to stabilize the break and allow better alignment. Read more about open surgery for wrist fractures

  • Arthroscopic Assisted Fixation

    Arthroscopic assisted fixation is performed using a camera to get a better look at the injury and align the fractures. This procedure is used primarily for distal radius fractures that involve the joint, but can also be used for carpal bone breaks. Because the cartilage or joint surface can be better aligned it allows for better outcomes. Read more about arthroscopic assisted fixation for wrist fractures

  • Wide Awake Local Anesthesia No Tourniquet (WALANT)

    Wide Awake Local Anesthesia No Tourniquet (WALANT) is a relatively new technique that eliminates the need for general anesthesia and a tourniquet through the use of lidocaine to block pain and epinephrine to control bleeding. It is more commonly used for fractures in the finger or hand, but can be possible for certain fractures of the wrist. Read more about Wide Awake Local Anesthesia No Tourniquet (WALANT) for wrist fractures.

Dr. Donnelly will explain your options and help you choose the procedure that is best for your situation.

Recovery Time

For the most part, the bones heal at the same rate for surgically and non-surgically treated fractures. It typically takes about 4 to 6 weeks for the bones to be stable enough to return to many activities. When surgical treatment is performed, plates and screws hold the fracture in place, and often can afford earlier motion (but not necessarily use) than non-surgical treatments that rely on casts and braces to hold the bones straight.

Although the fracture itself may be healed in 4 to 6 weeks, that doesn’t mean that the wrist is fully recovered. It takes time for the joints, tendons, and ligaments to regain their motion and strength. It can take 3 to 6 months for the arm to return to full strength.