The wrist is composed of two bones in the forearm, the radius (outer bone) and ulna (inner small joints. A wrist fracture refers to a break in one or more of these bones.
Types of wrist fracture include:
- Simple wrist fractures (Distal radius fracture) in which the fractured pieces of bone are well aligned and stable.
- Unstable fractures are those in which fragments of the broken bone are misaligned and displaced. Usually, such distal radius fractures are in many pieces (comminuted) or have an associated distal ulna fracture.
- Open (compound) wrist fractures are severe fractures in which the broken bones cut through the skin. This type of fracture is more prone to infection and requires immediate medical attention.
Wrist fractures may be caused due to a fall on an outstretched arm, vehicular accidents or workplace injury. Certain sports such as football, snowboarding, or soccer may also be a cause of wrist fractures. Wrist fractures are more common in people with osteoporosis, a condition marked by brittleness of the bones.
Signs and Symptoms
Common symptoms of a wrist fracture include severe pain, swelling, and limited movement of the hand and wrist. Other symptoms include:
- Deformed or crooked wrist
A preliminary physical examination is performed followed by imaging tests such as an X-ray of the wrist to diagnose a fracture and check alignment of the bones.
Sometimes a CT scan may be ordered to gather more detail of the fracture. MRI may be performed to identify tiny fractures and ligament injuries.
A bone scan may be required to identify stress fractures due to repeated trauma. The radioactive substance injected into the blood gets collected in areas where the bone is healing and is detected with a scanner.
Dr Bala may prescribe analgesics and anti-inflammatory medications to relieve pain and inflammation. Fractures that are not displaced may be treated with either a splint or a cast to hold the wrist in place. If the wrist bones are displaced, Dr Bala may perform a fracture closed reduction under sedation or anaesthesia and x-ray guidance to align the bones.. Dr Bala sometimes utilizes a small camera inserted into the wrist joint to assess and assist in fracture reduction. The reduction may need to be held with wires. A splint or a cast is then placed to support the wrist and allow healing.
Surgery is recommended to treat severely displaced wrist fractures and is carried out usually under general anaesthesia. Distal radius external fixation, such as pins may be used to treat the fracture from the outside. These pins are fixed above and below the fracture site and are held in place by an external titanium or carbon fibre frame outside the wrist. Distal radius internal fixation may be recommended to maintain the bones in proper position while they heal. Devices such as wires, plates and screws may be implanted at the fracture site either on the palm side or the back side of the wrist.
Crushed or missing bone may be treated by using bone grafts taken from another part of your body, bone bank or using a bone graft substitute. Special fractures require special plates called fragment specific plates which Dr Bala is well trained to use. Rarely in fractures that are in multiple small pieces an internal spanning fixator such as a locking plate maybe applied.
The tip of the ulna is often injured and does not need separate attention as it will fall into position on fixing the distal radius. Sometimes if the fragment is large it may need fixation with pins, wires or a fragment specific plate.
Often distal radius fractures can have an associated carpal bone fracture or dislocation which may often be missed. Dr Bala will discuss this in detail with you.
During the healing period, you may be asked to perform some motion exercises to keep your wrist flexible. Dr Bala may recommend hand therapy or physiotherapy to improve function, strength and reduce stiffness.
Risks and Complications
As with any procedure, wrist fracture surgery involves certain risks and complications. They include:
- Nerve impingement
- Residual joint stiffness
- Tendon or ligament injury
Dr Bala uses special magnification loupes to visualize and protect these structures to minimize complications. In the event you may have a tattoo on the forearm Dr Bala is well versed in suturing tattoos back accurately with absorbable sutures.
If you have pain, swelling, numbness or weakness of your wrist or hand after surgery you should contact your doctor immediately.
Dr Bala also deals with poorly treated wrist fractures with non-union, malunion stiffness or infection to salvage upper limb function.