Wrist Fractures: Overview

Wrist Fractures: Overview

A broken wrist or hand is a break or crack involving one or several bones within the wrist. The wrist is made up of 8 small bones, as seen here, which connect with 2 longer bones called the radius and ulna. A broken wrist may happen in any of these 10 bones, though, the most commonly broken bone is the radius. This is called a distal radius fracture by hand surgeons.

A broken wrist should be treated as soon as possible to avoid bones healing improperly and malalignment. This would affect the ability to do activities of daily living. Broken wrists are one of the most common injuries seen in orthopedic practice. They make up 8% to 15% of all bony injuries in adults, with more than 640,000 cases per year in the United States alone. Many of these cases require surgery.

Broken wrists may occur with damage to surrounding soft tissue leading to unstable joints and even carpal tunnel syndrome. Distal radius fractures have a bimodal distribution between young and old. Males aged 10 to 25 years are injured due to sports and auto accidents, and women older than 60 due to falls. Women, especially Caucasian, are four times more commonly affected than men.

Most distal radius fractures are caused by a fall onto an outstretched hand, commonly abbreviated as FOOSH. Breaking the wrist in this manner is so common, in fact, that it has a name called the Colles' fracture, after surgeon Abraham Colles who described it in 1814. The broken fragment shifts towards the backside of the wrist, as seen on this x-ray. Colles' fractures account for 90% of all distal radius fractures.

These other types of fractures make up the remaining 10%, namely Smith's, Barton's, Chauffeur's, and die-punch fractures. They occur by different angles of force when striking through the wrist, effectively breaking the 3 columns, or pillars of the long bones, shown in blue, green, and red. These basic types may even occur in combination, so some fractures are worse than others.

We can describe wrist fractures as stable and unstable. A stable, or nondisplaced break, is where the broken bones do not move out of place. Some displaced breaks can be stable too once they are put back into place and remain stable during healing. Stable breaks can usually be treated nonsurgically with a cast. On the other hand, unstable breaks are severe and shatter into many pieces called, comminuted fragments or fractures. They may look crooked or bent. These unstable types require surgery for realignment.

Fractures can also be described as closed or open. A closed fracture is when there is no rupture of the skin. An open fracture is when the fractured bone tears through the skin. There is a possible risk of infection in these cases and must be treated quickly. To prevent wrist fractures, be vigilant and wear protective gear during risky, unstable activities in sports.

Certain conditions can make bones weaker, especially osteoporosis, diabetes, and rheumatoid arthritis, so it is advised to maintain a healthy diet and weight for the bones to be strong if a fall does occur. Quitting smoking and diminishing alcohol consumption should also be in serious consideration.

Symptoms of a broken wrist can include pain, especially when flexing the wrist, tenderness, swelling, bruising, deformity of the wrist causing it to look crooked and bent. For initial diagnosis of a distal radius fracture, the doctor will take a number of x-ray images. A posteroanterior view and a lateral view are considered routine minimal evaluation. These images can help the assessment of both before and after a fracture has been treated.

A CT scan can give more significant information in comparison to a conventional x-ray because it can see complex fractures involving different sides of the bones in greater detail. It can also assess fracture healing after surgery, and is especially useful when plain films or x-rays are falsely normal looking. MRI is another powerful diagnostic tool to look at not only bony, but also ligamentous and soft-tissue abnormalities that might occur with this or radius fractures.

These abnormalities can be tears or perforations, occult fractures that might have been missed on a previous x-ray, broken blood vessels to wrist bones, this is called avascular necrosis of carpal bones, and the doctor can even see finger, tendon, and nerve injuries. Once these imaging diagnostics have provided the doctor the feedback he or she is looking for, treatment is planned.