Wrist Fracture

Introduction

A wrist fracture is a break or crack in one of the many bones within the wrist and hand. The most common of these injuries occurs in the wrist when people try to catch themselves during a fall and land hard on an outstretched hand.

Wrist anatomy

The wrist is made up of the two bones of the forearm (the radius and ulna) and eight carpal bones (scaphoid or navic

ular, lunate, triquetrum, pisiform

, trapezium, trapezoid, capitate, and the hamate). Many ligaments connect these bones to each other.

Symptoms

The amount of pain or the ability to move the wrist does not reliably determine whether the wrist is broken or sprained. However, a broken wrist tends to involve severe pain that increases during gripping or squeezing. Other symptoms include swelling, tenderness, bruising, stiffness or inability to move the fingers or thumb, numbness or coldness in the hand and obvious deformity, such as a bent wrist or crooked finger.

Diagnosis

A broken wrist needs to be treated as soon as possible, otherwise the bones may not heal in proper alignment, which can affect ability to perform everyday activities, such as grasping a pen or buttoning a shirt. Early treatment will also help minimize pain and stiffness.

Imaging scans are crucial to the diagnosis of a broken wrist. X-rays are the first port of call but if a fracture doesn't show up clearly on the X-ray, an MRI (magnetic resonance imaging) or CT (computerised tomography) scan may be used to take a closer look.

Treatment and surgery

Initially Mr Hull will fix a splint to the arm to secure it in position and prevent further damage. If it's a minor break or crack, a plaster cast to the wrist will suffice to hold the broken ends together while they heal.

For more severe fractures, an operation may be necessary to bring the bones together. First of all you will be given a general anaesthetic so that you are unconscious during the operation. Then Mr Hull will cut open the skin (open reduction) using a general anaesthetic and fix the bones using pins, rods or a plate and screws.

Once the bones have been aligned and the arm or wrist has been bandaged and set into a plaster cast, the arm will be secured to the chest with a sling. Plaster may not be needed if the bones are held in position with a metal fixation device.

Risks and complications

As with all operations, there is a possibility of a reaction to the anaesthetic, excessive bleeding, developing a blood clot and wound infection. A general anaesthetic may also make you feel temporarily sick after the operation.

There are also a number of specific possible complications related to wrist fractures. In some cases there may poor wound healing and reduced movement of the wrist. Nerves in the area may also be injured which can cause some numbness.

Arthritis in later life is one of the most common long-term complications affecting a broken wrist. When bones around the joint have broken they are likely to undergo more severe wear and tear than non-injured joints. Ultimately this can lead to pain and inflammation in the joint which may need further treatment.

Compartment syndrome is another possibility, which occurs due to increased pressure within a confined space, or compartment, in the body. If this happens, you may need further surgery to relieve the pressure.

Preparing for surgery

Mr Hull will talk to you about how best to prepare for surgery which may include stopping taking any anti-inflammatory medications such as aspirin to reduce the risk of blood clots and stopping smoking if you are a smoker to minimize the risk of infection.

If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand.

Mr Hull may also ask you to wear compression stockings to help prevent blood clots forming in the veins in your legs or may give you an injection of an anti-clotting medicine called heparin to help prevent blood clots forming in the veins in your legs. You will usually be put on an antibiotic drip before surgery. This is to reduce your risk of getting an infection during surgery.

Recovery

After the operation, you will need to rest until the effects of the anaesthetic have worn off. There is usually a moderate amount of pain for up to two weeks after the surgery which can be remedied using ice, elevation (holding their arm up above their heart), and simple, non-prescription medications for pain relief

The plaster cast will usually need to stay on for a few weeks, the time it takes for the bone to heal. The exact length of healing time depends on the type of fracture, whether it has damaged the surrounding tissues, and (to an extent) the age of the patient. Young patients tend to heal more quickly and may only need a cast or splint for two to three weeks.

Once your fractured bone has been set in place, you will need to build up the strength in the bone. Usually the cast stays on for about six weeks after which time Mr Hull may suggest you start with some gentle exercises or refer you to a physiotherapist. Almost all patients will have some stiffness in the wrist, which will generally lessen in the month or two after the cast is taken off or after surgery. Improvement will continue for at least two years.

It’s not unusual to feel some residual stiffness or ache for up to two years or possibly permanently. This is particularly the case for people over 50, patients with osteoarthritis and those who suffered a fracture due to a high impact accident. That said, the stiffness is usually minor and may not affect the overall function of the arm.

Further information

For further information please contact Mr Peter Hull FRCS, Consultant Trauma & Orthopaedic Surgeon.