What are wrist fractures?
Wrist fractures are the most common injury sustained when a person falls on an outstretched hand. In the younger population, wrist fractures may go through the growth plate of the radius. In the older (more osteoporotic) population, the fracture tends to go through the softer metaphyseal part of the wrist bones with some compression on the dorsal (back) side of the wrist with some angulation, shortening and displacement often displaying a dinner fork-type deformity.
Wrist injuries are more than just a crack or break in the bone: they tend to involve the ulna (thinner bone) with the injury usually causing disruption of the joint between radius and ulna. There are associated soft tissue injuries that cannot be appreciated on normal X-rays. The TFCC (triangular fibrocartilage complex) is a meniscus type structure in the wrist that stabilises the radius and ulnar and can be involved in up to 70% of wrist fractures. There might be associated carpal (scaphoid) bone fractures with other ligament injuries in up to 20% of wrist fractures.
What are the signs and symptoms of a fractured wrist?
The wrist is a very complex joint that involves the synchrony of ten bones and multiple soft tissue structures. The greatest problem with wrist fractures is stiffness and the loss of rotation, especially supination (turning the palm to the sky). Signs and symptoms of a fractured wrist include pain, swelling and difficulty in moving the hand and wrist. Swelling, or when the bone is out of place, may make your wrist appear deformed. This can be prevented by early immobilisation. Left untreated, the broken wrist bone might not heal in proper alignment, which may affect your ability to do daily activities such as writing or buttoning your shirt.
How are wrist fractures treated?
Most wrist fractures can be treated with a cast or splint to immobilise the wrist and thereby facilitate bone healing. In displaced or unstable wrist fractures, the best treatment is wrist surgery to reduce the bone fragments in the correct position and to then stabilise the fracture by fitting a plate, which keeps the bone fragments in a reduced position. This is called an open reduction and internal fixation (ORIF). A stable fixation facilitates early mobilisation and ensures a good outcome.
Generally, treatment goals for wrist fractures are initially to reduce swelling and to get the fingers moving as soon as possible. Dr van der Spuy will immobilise your wrist for approximately 4-6 weeks with conservative management in a cast. With a surgical fracture fixation, this can be a bit earlier between 2-4 weeks, and movement of the wrist can start once the fracture stable enough. Most patients will experience stiffness and some discomfort and pain for up to six months post-surgery, depending on the severity and complexity of the wrist fracture.
Rehabilitation, including splinting, will be required to ensure good finger and thumb movement, as well as oedema and scar management in the early days' post-injury/ hand surgery. Once the fracture is considered stable, hand therapy will help to regain movement of the wrist in all planes, build strength in the hand and facilitate the return to normal function.