Wrist Fractures: Treatment Options

Wrist Fractures: Treatment Options

If a broken wrist is left untreated, the bones will begin healing improperly and misaligned. This will affect activities of daily living and remain detrimental to life. Misaligned joint surfaces will develop arthritis within the incongruent joint spaces, which may cause pain, instability, and even weakness of muscles, tendons, and ligaments over time.

Treatment of a broken wrist will depend on the severity of the fracture. Let us take a look at the different options. Closed reduction and immobilization with casting is the most basic form of treatment. This is nonoperative for fractures with really minor fragmentation or combination and very minimally displaced fractures.

For surgical treatment, here is the list of options we will explore next. Closed reduction and percutaneous pinning may be done in the operating room for simple fractures, especially in children. This is where the doctor realigns the fracture without an incision and may place a metal pin into the bones for added stability before a solid cast is molded around the wrist.

There may be a single metal wire or pin, as seen here, for one larger fragment, or 2 metal pins inserted for two or three large fragments. These can protrude some and may be felt, but not to worry, these will be at least removed later when the fracture has healed.

Closed reduction with external fixation is next. External fixation is a device inserting larger pins into the radius and hand bones connected by stout rods outside the body. This is used in severe trauma cases, for example, in motor vehicle accidents with multiple injuries and fractures or a dysfunctional limb. The device helps to maintain stability of fractures, especially if wounds are open and need to be cleaned and disinfected.

The most common and precise treatment today for wrist fractures is open reduction and internal fixation. This is often referred to as ORIF. This involves one or more incisions and placement of one or more metal plates onto the fractured bones to achieve proper alignment and reduction. These plates may be removed through smaller incisions after healing, though some are left in for life.

There are two groups of fractures where ORIF is especially beneficial. The first group is the two-part shear fracture or Barton's fracture, since they are unstable and difficult to control in a cast. The second group includes more complex fractures where fragments are rotated and even impacted together. ORIF achieves articular congruency or alignment in patients with very badly broken up or comminuted fractures.

There are many different plates, so let us familiarize ourselves with some commonly used ones. The most common and current standard of care today is called volar plate fixation. This plate is inserted from the underside of the wrist and is a rigid biomechanical construct, allowing near-immediate functional wrist loading and activity.

Dorsal plate fixation was popular in the past and is still used for specific fracture patterns, especially more on top of the wrist. Fragment-specific fixation is reserved for fragments so small and comminuted that they require multiple different plating techniques to fix them. All of the fragment-specific plates have unique incisions for easy access and placement of these plates.

In summary, there are many different options available to treat any type or severity of a fracture with the purpose and thought to get the patient to heal as close to normal anatomy as possible and get back to enjoying life.