Bitterroot Orthopedics and Sports Medicine
A service of Marcus Daly Memorial Hospital
Michael Dolecki, MD
1200 Westwood Drive
Hamilton, MT 59840
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
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!