What is it?
The wrist contains 8 small bones that form a joint with the two bones in the forearm, the Radius and the Ulna. The term 'wrist fracture' tends to refer to a break in one or both of the forearm bones near the wrist. The Radius is the more commonly affected.
What causes it?
Wrist fractures normally result from a fall onto the outstretched hand. These fractures are encountered most often in children and young adults following sporting injuries and road traffic accidents and in the elderly where they tend to signify a weakening in the bones.
What are the signs and symptoms?
Pain over the wrist is the primary feature but the wrist may also be bruised, swollen and in some cases, obviously deformed . Pins and needles in the fingers may result from pressure on the median nerve at the wrist if the wrist is deformed or very swollen.
How is it diagnosed?
A wrist fracture is often apparent from the history and examination findings alone. Plain X-ray images will confirm the presence of the fracture. A CT scan may be required in more complicated cases and an MRI scan may be necessary to rule out injuries to other structures such as ligaments.
How is it treated?
The treatment is dependent upon a number of different factors:
Age of injury: Earlier treatment generally results in better outcomes. When fractures have been neglected and have failed to heal an operation becomes more likely and the result is not as reliable.
How much the fracture has moved from it's normal position: Wrist fractures that have not moved a great deal from the original position (undisplased) can normally be treated without surgery and will require a plaster cast for 6 weeks. Fractures in which the fragments have moved apart (displaced) will in most cases require surgery.
How many pieces the bone has broken into: Fractures that result in multiple pieces (comminuted) are less stable and can necessitate surgery.
Has the fracture line entered or disrupted the surface of the joint: Fractures the do not involve the joint surface (extra-articular) can often be treated without surgery as long as the bone ends have not moved too far from the original position. Fractures that disrupt the joint can predispose to arthritis in the longer run and are therefore more likely to be treated with an operation to restore the joint surface.
Other associated Injuries: Wrist Fractures can often occur with a combination of other bone or ligament injuries. In a situation where there a multiple injuries an operation may become necessary.
What does the operation involve?
The nature of the operation will depend on the fracture type and the delay between the injury and the operation. The operation will be performed with you asleep and in most cases is performed as a day case procedure. The more straight forward wrist fractures will be fixed with small wires (K wires) after the wrist has been reset to allow the new position to be maintained. The more complex fractures often require an open operation where the fragments are fixed back together with a combination of screws and a plate. Rarely an external fixator may be required and this sits over the wrist outside the skin and is only really used where the wrist is badly damaged.
For fractures treated with K wires a plaster cast is required for 6 weeks. You will be reviewed in clinic a week after your operation. This is to inspect the small wounds created to allow the wires to enter the bone through the skin. You will also have your preliminary cast (backslap) changed to a full cast. For fractures treated with internal fixation such as a plate you are likely to remain in a bulky soft bandage for 2 weeks. You will then be reviewed in clinic for a wound check and physiotherapy commenced from 2 weeks. It is occasionally necessary to keep you in a plaster after a plate fixation and this is likely to be for a period of between 2-4 weeks.
Return to work
This is dependent on the operation and the nature of your work. This will be discussed with you during your consultation.
Driving is only really possible once you are out of cast and even then it can take a couple of weeks out of cast before you can drive comfortably.
Like with any surgery there are a number of small risks associated with this operation.
Infection (1%) is a risk with all surgery. In the majority of cases these are infections around the wound and can be treated with a course of antibiotics. The more unusual deep-seated infections however can require admission to hospital and surgery to clean the wound out if necessary.
Swelling and Stiffness can remain for many months following surgery. It is important to elevate the limb and keep all joints that are not immobilised with a splint, active.
Fracture not healing (non-union) although most fractures will go on to heal, there is a risk that the fracture may not heal and may require further surgery.
Scar Sensitivity is often a problem with surgery in the hand, particularly the palm. This is often self-limiting and daily massage of the scar can shorten the duration of the symptoms. The sensitivity does settle is all cases with time.
Nerve Injury is a potential but very rare risk with this surgery. Often the nerves at greatest risk are the tiny nerves supplying skin in the area of the wound and cutting through these may result in an area of numbness that is not often troublesome.
Complex Regional Pain Syndrome is an extremely rare (1%) complication that can follow any injury or surgery to a limb. In this situation the nerves in the arm over-react to the point where the hand becomes very painful, swollen and sensitive. This condition does improve with time but can be problematic for many months (see section on Complex Regional Pain Syndrome).