Hand and Wrist

Wrist, Distal Radius Fracture

Anatomy/Description

Bones of the forearm include the ulna and the radius, which is the larger of the two. When the area of the radius near the wrist (distal end) breaks it is called a distal radius fracture.

Symptoms

A broken wrist is usually accompanied by immediate or acute pain, tenderness, bruising and swelling. The wrist may appear deformed, hanging at an odd angle or in an unusually bent way.

Causes

A broken wrist, or distal radius fracture, is a common fracture that can occur even in healthy bone if the force of trauma is severe enough. This break often happens as a person lands on an outstretched hand when trying to break a fall. Automobile, biking, skiing and other similar accidents are also frequently causes. Osteoporosis increases the risk for this type of fracture, even during a relatively minor fall.

Diagnosis

An X-ray will allow your physician to diagnosis your fracture and determine its type before choosing the most appropriate and effective treatment. A distal radius fracture typically occurs about one inch from the end of the bone, in one of several different ways, including: an intra-articular fracture, which extends into the joint; an extra-articular fracture, which does not extend into the joint; an open fracture, where the bone breaks the skin; and a comminuted fracture, where the bone is broken into more than two pieces.

Immediate Treatment

If the injury is extremely painful, if the wrist appears deformed or feels numb, or if the fingers are not pink or their normal color, it is necessary to go to the emergency room immediately. If the injury is not too painful and the wrist appears relatively straight, it may be possible to wait until the next day. Protect it with a split, apply an ice pack, and elevate the wrist above your heart to help minimize swelling until you can be examined by a physician.

Nonsurgical Treatment

Depending on the nature and severity of your fracture, there are various treatment options. If your broken wrist is not straight, it must be realigned, or reduced, so it can heal properly. When this is done without an incision, it is called a closed reduction. Once the bone is properly aligned, a splint may be placed on your arm for the next few days to allow for the normal amount of swelling. A cast can be added a few days to a week or so later, after some of the swelling has gone down. This cast may need to be changed after two or three weeks as the swelling continues to go down and the cast begins to loosen. For some fractures, periodic X-rays may be needed to monitor the healing process.

Surgery

Surgery may be required if the fractured bone is so far out of place it cannot be realigned without an incision, or if a cast alone cannot sufficiently hold the bone in place, both of which have the potential to interfere with the functionality of your arm after it heals. An open reduction allows your surgeon directly access the broken bones to improve accuracy of alignment. There are a number of options for fractures that require support beyond a cast to keep the bone in position, such as: metal pins (usually stainless steel or titanium), a plate and screws, an external fixator (a device for which most of the hardware remains outside of the body), or any combination of these techniques.

Recovery

Although healing and recovery varies depending on the injury and individual, some generalizations can be made. You may expect moderate pain for a few days up to a couple of weeks. Elevating the arm above the heart and over-the-counter pain medications should provide relief. If pain is severe, your physician may give you a prescription for stronger pain medication to be taken for several days.

Casts and splints must be kept completely dry. During showers the arm can be covered with a plastic bag. If the cast does become wet, it will not dry easily. A hair dryer on the cool setting will help dry it out more quickly. Most surgical incisions must be kept clean and dry for five days or until the sutures (stitches) are removed.

The cast is typically worn for approximately six weeks. After it is removed, physical therapy may be recommended to help improve motion and function of the injured wrist. Within a month or two after the cast is removed, you may be able to resume light activities such as swimming or lower-body exercise. Vigorous physical activities, such as skiing or football, can often be resumed after three to six months.

After cast removal, most patients will experience some stiffness in the wrist for a few months. During the recovery period, some pain may accompany vigorous activities, as well as minor residual stiffness or aching, which in certain cases may be permanent. Recovery should be expected to take at least a year, with continued improvement for two years or more.