WRIST FRACTURES
What are they?
The wrist is made up of eight small bones, called carpal bones, and two long forearm bones, called the radius and ulna. The shape of these bones and the special way they move against each other allows the wrist to bend up and down, side to side and turn over.
A fracture may occur in any of these bones when enough force is applied, such as when falling down onto an outstretched hand (Called a FOOSH injury). Anybody can have a fracture but osteoporosis is a common condition in which bones become brittle and this makes them more susceptible to getting a wrist fracture.
The most commonly broken bone of the wrist is the radius. This type of fracture is called a
distal radius fracture. Often the wrist looks crooked or deformed after this type of fracture.
Fractures of the small wrist bones, such as a
scaphoid fracture near the base of the thumb, are unlikely to appear deformed. Scaphoid fractures can be very difficult to heal, heal slowly, and non-union rates are higher for this carpal bone.
How is it Diagnosed?
Examination and x-rays are needed so that your doctor can tell if there is a fracture and to help determine the treatment. Sometimes a CT scan or MRI may be used to get better detail of the fracture fragments and associated injuries.
In addition to the injury to the bone, ligaments (the structures that hold the bones together), tendons, muscles, and nerves may also have been injured when the wrist is broken.
These injuries may need to be treated in addition to the fracture.
Complications
A fracture or a broken bone means the same thing. The difference is in the description of the type of fracture. A fracture could be spiral, oblique, transverse, displaced, or comminuted (broken into multiple pieces).
Fractures may be simple with the bone pieces aligned and stable. Other fractures are unstable and the bone fragments tend to displace or shift in which case the wrist is more likely to appear crooked.
Sometimes the bone is shattered into many pieces, which usually makes it unstable. An open (compound) fracture occurs when a bone fragment breaks through the skin. There is some risk of infection with compound fractures.
More than one bone can be fractured at the same time or the fracture can be so close to a joint that the cartilage (the smooth cushion at the end of the bone) is damaged. This can lead to complications down the road such a osteoarthritis and
painful wrist movement.
In rare cases a person may develop a complication called chronic regional pain syndrome known as
CRPS which will delay healing. If you have any concerns about your arm following a fracture it is important to discuss those feeling early so your team can help you.
Treatment
The type of fracture will determine the type of treatment. Other important considerations include your age, overall health, hand dominance, work and leisure activities, the presence of any prior injury or arthritis, and any associated injuries.
A splint or cast may be used to treat a fracture that is not displaced, or to protect a fracture that has been set. Other fractures may need surgery to properly set the bone and/or to stabilise it.
Fractures may be stabilised with pins, screws, plates, rods, or external fixation. External fixation is a method in which a metal frame outside the body is attached to pins which have been placed in the bone above and below the fracture site, in effect keeping it in traction until the bone heals.
Your hand or orthopaedic surgeon will decide which treatment is the most appropriate in your individual case.
On occasion, bone may be missing or may be so severely crushed that there is a gap in the bone once it has been re-aligned. In such cases, a bone graft may be necessary. In this procedure, bone is taken from another part of the body to help fill in the defect. Bone from a bone bank or synthetic bone graft substitutes may also be used.
What can Hand Kinetics do?
While the wrist fracture is healing, it is very important to keep the fingers flexible, provided that there are no other injuries that would require that the fingers be immobilised, such as other fractures or nerve or
tendon repairs needing their own specific management. Otherwise, the fingers will become stiff, hindering the recovery of hand function.
Once the wrist has enough stability, either by sufficient healing of the bone or with the help of plates and screws to stabilise them, it is safe to start gentle controlled exercises for the wrist and fingers. It is also helpful to stretch and exercise the uninjured joints such as the elbow and shoulder as wearing a cast can be heavy for them and keeping the arm still can make them stiff and weak. (see
Frozen shoulder)
It is important to do the correct exercises and your Hand Kinetics Hand therapist can work with your doctor to determine the appropriate timing for these exercises.
Hand Kinetics will work with you to help you to recover flexibility, strength, and function in your hand.
What kind of results can I expect? 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 or swelling which can be helped with appropriate hand therapy and exercises.
Please note:
If you have had arm or hand surgery please telephone to discuss this before attending. It is always helpful to bring any x-ray reports you may have if you recently attended hospital for your hand or arm condition.
Hand Kinetics Telephone: 0044 28 417 72301
www.handkinetics.com
contactus@handkinetics.com
