Wrist fractures are the most common injury sustained when a person falls on an outstretched hand. In the younger population, the fracture might 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 bone 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 fibro cartilage complex) is a meniscus type structure in the wrist that stabilises the radius and ulna, 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.
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 are stiffness and the loss of rotation, especially supination (turning the palm to the sky). This can be prevented by early mobilisation. Most wrist fractures can be treated in a cast or splint to immobilise the wrist and thereby facilitate bone healing. In displaced or unstable wrist fractures, the best treatment is to operate 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 are initially to reduce swelling and to get the fingers moving as soon as possible. The wrist will be immobilized between 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 fracture is 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 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/surgery. Once the fracture is considered stable, therapy will work on regaining movement of the wrist in all planes, building strength in the hand and facilitating return to function.