Wrist Fractures

Bitterroot Orthopedics and Sports Medicine
A service of Marcus Daly Memorial Hospital
Michael Dolecki, MD
1200 Westwood Drive
Hamilton, MT 59840
(406) 375-4868

Wrist Fractures
Wrist fractures are one of the most common injuries in adults. Since the wrist is a joint, not a bone, it is not what breaks. Most frequently a "wrist" fracture is a break that occurs at the end or distal part of the radius bone. This type of fracture was first described by Abraham Colle in 1814 so it goes by the name "Colle's Fracture". Much confusion occurs around the term "brake" or "fracture". Simply put a fracture is a broken bone, a broken bone is a fracture, they are one in the same. Many terms apply to fractures such as hairline, displaced, etc., but no matter how a bone breaks, fracture=broke bone.

The majority of distal radius fractures occur when one falls on an outstretched wrist. It is a normal reaction to put our hands out to try to catch ourselves when we fall. If enough force gets directed to the bone, it will break. Depending on how much force occurs, the pattern of distal radius fractures will vary.

In minor falls, the radius may simply break but stay in position. As more force is applied, the fractured radius may move out of position or displace, causing a deformity. In even more forceful injuries, the radius may break in multiple pieces called comminution. If the fracture extends into the wrist joint, it's called an intra-articular fracture. If so much force is applied to the wrist, the broken radius may even protrude through the skin called an open fracture.

Treatment of radius fractures depends on the severity of the break and how much displacement or deformity occurs. The best way to determine this is with X-rays or a CT scan. In the minor break where the bone has maintained its position, application of a splint or cast is sufficient. Because swelling can occur after the injury, a splint is usually applied first to allow for the swelling to diminish. Ice and elevation of the injured arm helps in this process. Once the swelling improves in 1-2 weeks, conversion to a hard cast will occur for 4-6 weeks. If the broken radius has moved out of position, then a manipulation or closed reduction of the bone under anesthesia needs to reposition the bone back to proper alignment. This is followed by splinting/casting. If the displacement is severe or extends into the wrist joint then surgical open reduction may be necessary. The addition of metal pins, plates, or screws may be needed to help hold the broken bone in proper alignment. In the case of an open fracture through the skin, cleaning out the wound, prescribing antibiotic to prevent infection, and applying an external device called a fixator is sometimes required.

After the fracture heals in 6-8 weeks and casts can be removed, it is typical that stiffness of the wrist occurs. Referral to a physical or occupational therapist can help restore motion and function of the hand and wrist. Light activities can be resumed typically in 2-3 months. Sports and heavy activities may take longer. It is not unusual for total healing time after a wrist fracture to be 6-12 months.

Good bone health remains important in the prevention of wrist fractures. Maintaining an adequate intake of calcium and vitamin D supports good bone health. Another means of prevention is wearing wrist guards for activities such as biking, skate boarding, roller blading, etc. where the chance of falling on an outstretched wrist can occur. Aside from the distal radius, another bone within the wrist which can break with a fall is the scaphoid bone. Treatments ranging from casting to surgery can be required.

Unfortunately, the scaphoid bone has a track record of being the slowest or one of hardest bones to heal. Early diagnosis is essential, so if wrist pain or deformity occurs after a fall, be sure to see your nearest Orthopaedic Surgeon for an evaluation and Xray.

Questions and or comments regarding this week's health column please contact Michael Dolecki, MD at Bitterroot Orthopedics and Sports Medicine, a service of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840. Working together to build a healthier community!