A broken wrist is a break or a crack in one of the bones in the wrist. The most common cause of a fracture in the wrist is a fall on the outstretched hand or arm. These injuries often occur in the young from sporting activities or after a simple fall in the elderly due to osteoporosis. Osteoporosis is a disorder where the bone become fragile and weak, making it more prone to fractures. Many fractures in the wrist in the elderly arises after a fall from a standing position.
It is important to treat a broken wrist as soon as possible. If not, there is a risk that the bone will not heal in the proper alignment. This will affect the ability of the affected wrist or hand to perform everyday activities such as writing. Proper treatment early on will reduce the problems of pain, stiffness or weakness if neglected.
Description - Anatomy
The radius is the larger of the 2 bones in the forearm (red arrow). The end of the radius at the wrist is known as the distal radius. The radius interacts with other bone in the forearm, the ulnar (yellow arrow) to allow rotation movements in the forearm and wrist.
Fractures in the distal end of the radius are very common. The radius is the most commonly broken bone in the arm!
What is a distal radius fracture?
A distal radius fracture is a fracture of the end of the radius close to the wrist. The break can occur in a variety of ways.
One of the most common types of distal radius fractures is a Colles Fracture (picture above). In this fracture type, the broken piece of the radius tilts upwards or towards the back of the wrist, resulting in what we call a “dinner fork” deformity. This fracture was first described by an Irish surgeon in 1814 by the name of Abraham Colles, and hence its name.
The other type of fracture patterns includes:
- Intra- articular fracture. This type of fracture extends into the wrist joint.
- Extra- articular fracture. The Colles fracture is a type of extra- articular fracture. The fractures do not extend into the joint.
- Open fracture. An open fracture is a fracture where the bone breaks the skin and creates a wound. This type of fractures requires immediate attention due to increased risk for infection.
- Comminuted fracture. A comminuted fracture is where the bone is broken into multiple pieces.
At times, the distal end of the ulnar can also be broken.
Symptoms of a broken wrist
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If you’ve had an injury to your wrist and experience these symptoms, you might have broken your wrist.
- Severe pain in the wrist or hand
- Moving the wrist or fingers causes pain
- Swelling
- Tenderness in the wrist
- Bruising
- Obvious deformity in the wrist, e.g the “dinner fork” deformity
- Numbness in the hand
If the injury is not very painful or the wrist is not deformed, it may be possible to wait until the next day to see the doctor. An ice pack can be applied to help with the pain and swelling. Having the wrist and hand elevated on a soft pillow or cushion is useful.
At the Doctor's Clinic
The doctor will take a history and examine your wrist. To confirm the diagnosis, x-rays are commonly taken and will be able to show if the bone is broken and assess its severity and displacement. At times, a CT (computed tomography) scan may be needed if the fracture is complex.
Treatment
Treatment of broken bone follow these simple rules:
- to reduce the fracture (place the broken pieces back into its original position)
- maintain the position of the fracture fragments until healing
There are many treatment options for a distal radius fracture. The choice depends on many factors such as the severity of the injury, the patient’s age and activity level and the overall health of the patient.
Non-Surgical Treatment
If the fracture or broken bones are in a good position, a plaster cast can be applied until the bone heals.
What is more common is that the position of the broken bones is out of place. In this situation, it is necessary to re-align the fragments back to the original position. Leaving it misaligned can cause problems like stiffness, pain and swelling in future. The process of manipulating the bones back to position is called “closed reduction”. Once the broken fragments are in a good position, the hand and wrist are placed in a plaster cast. This needs to be monitored until healing is completed. Closer monitoring may be needed if the fracture is thought to be less stable. In our hot and humid climate, it is important to keep the arm cool and dry. Never try to use long sticks and objects to scratch the hand inside the cast.
The cast is usually removed at 6 weeks after and physiotherapy is often started to help improve the motion and function of the wrist and hand. The fracture takes an average of 3 months to heal completely.
Casting applied on a wrist with a distal radius fracture
Surgical Treatment
Surgical treatment for distal radius fractures may be required if the fracture pattern is such that the bones cannot be corrected or kept corrected in a proper position using a cast. If not properly treated, there is possibility of inadequate healing or healing in a poor position that result in the function of the wrist and hand to be impaired in future.
During surgery, the fracture fragments are manipulated back into their original positions via an open incision on the wrist. This is called “open reduction”. Once achieved, the fracture is often fixed with a metal implant consisting of a plate and screws.
Pictorial diagram of a fixation device for distal radius fractures (Picture coutesy of DePuy Synthes)
With open fractures, surgery is required on an urgent basis. The exposed soft tissue wound and the fractured bone must be thoroughly cleaned (debrided) and antibiotics are usually given to prevent infection. Should the soft tissues about the fracture be badly injured, an external fixator may be used to stabilise the fracture. Definitive fixation with plate and screws can be done several days after.
An external fixator in place for a distal radius fracture
Recovery
There is a large variability in the severity and types of distal radius and wrist fractures. The treatment options and recovery process is therefore different with each individual. It is important to talk to the doctor and he will tell you the details regarding your injury and recovery path.
In general, most surgical wounds take 10 days – 2 weeks to heal. After surgery, the doctor will prescribe you a course of medicines to relieve pain. The fracture takes about 3 months to heal completely. Most patients will have some stiffness in the wrist due to the nature of the injury. The doctor will start you on physical therapy as soon as you are ready to maximise the recovery of the wrist. Light activities can be resumed at about 6 weeks after surgery while more strenuous activities can be started at 3- 4months.
Broken Wrist Prevention
It is impossible to prevent the unforeseen events. However, these simple steps and tips can offer some protection.
We can build strong bones by:
- Having a healthy diet with adequate calcium and vitamin D.
- Participating in impact or load bearing exercises such as jogging will help increase the bone mass.
- Stopping smoking
We can minimise accidents and falls by:
- Wearing proper foot wear
- Remove home hazards, such as loose rugs. Many falls occur at home!
- Have adequate lighting and install night lights.
- Ensure your vision is checked and corrected.
- Consider installation of hand rails and grab bars in the toilets and stairways.
- Wearing protective gear at sports such as knee and wrist guards.
