Wrist fractures – A.K.A. a broken wrist – are one of the most common orthopedic injuries treated every year, both in the United States and globally. The most common cause of the break is a fall on an outstretched hand. However, there are many other ways in which a wrist fracture can be produced.
Wrist fractures can vary in their nature and presentation. For example:
Although there are common fracture patterns among patients with a broken wrist, each fracture is ultimately unique and needs to be treated accordingly.
In addition to the break(s) associated with the fracture, there is also often injury to the surrounding soft tissues (i.e. the bone covering or periosteum, tendons, ligaments, or nerves) when the fracture occurs. These soft tissue injuries must be recognized and treated in order to prevent "soft tissue disease", which may result in scarring and stiffness.
Finally, the patient and their health and history must also be considered. Factors such as age, general health, osteoporosis, smoking history, and malnutrition can each affect fracture healing.
Careful assessment of the full extent of a fracture and the affected joints or soft tissues is critical to prepare a complete, targeted fracture treatment plan. This may involve:
In general broad terms, stable, undisplaced, extra-articular fractures of the wrist are usually treated conservatively, i.e. with a protective splint or cast.
In such cases where osteoporosis is known or suspected, frequent repeated x-rays and evaluation may be necessary to avoid later compression and collapse of the fracture, even in a cast or splint. In these cases, an external fixator or percutaneous pins may be applied to help try and prevent such collapse.
A plaster splint may also be used together with these techniques to help hold the fracture. Usually, occupational therapy will be started right away to reduce swelling (edema control) and start finger motion exercising.
For severely displaced fractures with an angular or rotational deformity - and for displaced fractures that involve the joint – open reduction and internal fixation surgery (ORIF) may be necessary.
Despite our best efforts and external or internal fixation procedures, delayed healing or further settling of the fracture can occur. Arthritis of the affected joints can develop, as well a stiffness of the wrist and fingers. This is sometimes an unfortunate side effect of the fracture and affected bone, which cannot always be avoided.
Other risks are anesthesia-related problems, wound healing problems, and potential infection.
Note that sometimes a second surgery may be required to remove the orthopedic hardware or correct some of the residual problems from the fracture.