Wrist Fractures

Types of Wrist Fractures

• Distal Radius Fracture: This is the most common type of wrist fracture. The wrist is made up of two forearm bones called the radius and the ulna, the radius being the larger bone. A distal radius fracture happens when the distal end of the radius bone (closest to the wrist) breaks. 
• Distal Ulna Fracture: This happens when both the radius and the ulna bones are broken.
• Scaphoid Fracture: This is the second most common type of wrist fracture and it can be difficult to treat. The scaphoid is one of the carpal bones in the wrist near the base of the thumb. The closer the break is to the thumb, the greater the chance that nonsurgical treatments will work effectively. Additionally, the healing process becomes more difficult the farther the break is from the thumb because the area doesn’t receive a large blood supply, and good blood flow is essential for healing. 
• Barton’s Fracture: This type of fracture is less common than the others. It is essentially a distal radius fracture along with a dislocation in the wrist (radiocarpal) joint. Barton’s fractures typically require broken wrist surgery to repair.
• Chauffer’s (Radio Styloid) Fracture: This type of fracture happens when the radial styloid (the bulge at the end of the ulna bone, near the base of the thumb) breaks. A Chauffer’s fracture often requires broken wrist surgery to repair.
• Ulnar Styloid Fracture: The ulnar styloid is the visible bulge on the outside of the wrist. This type of fracture happens when that bulge breaks. An ulnar styloid fracture often happens along with a distal radius fracture due to a fall, and usually requires surgery to repair.

What Causes Wrist Fractures?

The most common cause of a broken wrist is trauma, such as falling onto an outstretched hand or getting hit on the wrist. Broken wrists are very common in people who play contact sports, as well as skiers, skaters, and bikers. 

People with osteoporosis are also at risk for wrist fractures because their bones are actively thinning, making potentially any accident a broken bone risk.

Symptoms of a Broken Wrist

But how do you know for sure if you have a sprained wrist or a broken one? Symptoms of a broken wrist can include:

• Pain when moving the hand or wrist
• Swelling
• Bruising
• Wrist deformity, causing it to look crooked or bent

Your nerves or blood flow may be affected depending on the severity of your broken wrist. If you’re experiencing any numbness in the hand, wrist, or arm, or you have extremely pale fingers, you should see one of our Dallas orthopedic surgeons immediately.

How to Diagnose a Broken Wrist

To diagnose a broken wrist, a SPORT Orthopedic doctor will give you a physical exam. If the fracture is hard to see from an exam, your doctor may set up an X-ray to get a better picture of your injury. Sometimes, even an X-ray doesn’t give doctors enough detail of the break, so they may resort to a CT scan or an MRI.

Imaging Tests

• CT scans can show wrist fractures that X-rays miss, such as soft tissue and blood vessel injuries. CT scans provide a better picture because it takes X-rays from multiple angles and combines the images to show cross-sectional slices of your injury.
• MRI’s are much more sensitive than X-rays because they use radio waves and a powerful magnet to produce images of bone and soft tissues. MRI’s are very successful in showing small fractures and ligament injuries.

How to Treat a Wrist Fracture

Reduction

The most common way to treat a broken wrist is for your doctor to manipulate the wrist pieces back into their proper position, which is called reduction. Depending on your pain and swelling, your doctor may give you a local anesthetic before doing this.

Immobilization

Not moving your broken wrist after reduction is critical to healing and getting full function back. To prevent moving your wrist, your doctor will give you a splint or a cast. It’s also important to elevate your wrist as much as possible to reduce swelling and pain during the healing process.

Medication

Your doctor may give you an over-the-counter pain reliever during your recovery. If your pain is severe, you may need an opioid medication such as codeine. However, make sure to ask your doctor if you can use NSAIDs for pain relief (such as ibuprofen, naproxen or aspirin), because these can hinder bone healing. 

If you have an open fracture (when the bone breaks the skin), your doctor will give you an antibiotic to prevent infection which could reach the bone.

Rehabilitation

Once your splint or cast is removed, you will need to undergo rehabilitation to regain full function of your wrist and hand. A Dallas physical therapist will give you multiple exercises to reduce stiffness and restore movement.

Broken Wrist Surgery

For more severe fractures, you will need broken wrist surgery. Our Dallas orthopedic surgeons may implant pins, plates, rods, or screws to hold your wrist bones in place while they heal. A bone graft may also be used to assist the healing process. Surgery is the best option for you if you have:

• An open fracture
• A fracture where the bone pieces move before they heal
• Loose bone fragments that could enter a joint
• Damage to surrounding ligaments, nerves, or blood vessels
• Fractures that include a joint

Even if you don’t need broken wrist surgery at first, you may need it after reduction and immobilization because your bones may have shifted. One of our Dallas orthopedic surgeons will monitor your wrist’s healing through various scans. If the scans show a shift in the bones, you will need surgery.

Complications of Broken Wrist Surgery

Just like any surgery, complications can arise from broken wrist surgery. Additionally, different types of broken wrist surgeries come with different complications. 

Complications from Internal Fixation

Internal fixation is a procedure where a surgeon aligns your wrist bones with plates, screws, or pins. Possible complications include:

• Loss of fixation
• Improper positioning of the plate or screws
• Infection
• Needing hardware removal
• Nerve injury
• Tendon injury or rupture
• Stiffness

Complications of Percutaneous Fixation with Pins and Casting

Some types of fractures are unstable in a cast alone. When this happens, a surgeon will stabilize the fracture with one or more pins before applying a cast. Possible complications include:

• Loss of fixation
• Loss of reduction
• Pin infection
• Needing another operation
• Nerve or tendon injury
• Stiffness

Complications of External Fixation

This type of procedure involves an external frame that holds pins in place which are inserted in the bone through small incisions on both sides of the wrist fracture. The external fixator is used along with percutaneous pins and bone graft to support the broken bone fragments and reduce the need for the fixator to apply traction. This technique allows for the fingers to be used for daily activities after surgery. Possible complications include:

• Wrist and hand stiffness
• Pin tract infection
• Nerve injury
• Loss of reduction
• Re-operation

How to Prevent Wrist Fractures

It’s impossible to foresee if a fall, a car accident, or a sports injury will happen in your future, causing you to break your wrist. But you can take daily steps to take care of yourself, which will hopefully prevent injuries.

Build Bone Strength

The best way to prevent broken bones is to make sure they’re strong in the first place. To do this:

• Eat a nutritious diet
• Take calcium and vitamin D supplements, which support bone health
• Exercise regularly
• Stop smoking because this can prevent or delay bone healing

Prevent Falls

Falling on an outstretched hand is one of the most common causes of broken wrists. To limit or prevent your falls:

• Wear comfortable shoes that you’re not likely to trip over
• Remove items from your home that you could trip over, like throw rugs
• Make sure you have plenty of light and visibility in your living space
• Have your vision checked or possibly corrected
• Install grab bars in your bathroom
• Make sure the stairs in your home have handrails
• Avoid slippery surfaces if possible, such as snow or ice-covered walkways

Use Protective Gear

If you’re an athlete, make sure you’re protected during every practice and game. Make sure to wear wrist guards for:

• In-line skating
• Snowboarding
• Rugby
• Football