WRIST FRACTURES 

Broken wrist is an umbrella term that covers many different types of fractures affecting the wrist. It can be a fracture of one of the small bones of the wrist (scaphoid fracture would be the most common one) or fracture of one of the 2 longer bones in the forearm (radius and ulna). Further more there are different types of fracture depending on what way the bone is broken and we will touch on that a little on this page. But this page is going to focus mostly on the distal radius fracture.

Distal radius fracture is the most commonly broken bone in the arm. It happens when the radius, which is one of the long bones of the forearm, breaks close to the wrist. The most common type of broken wrist is Colles fracture and it is one of the conditions we see in our hand clinic most frequently.

how do you know if your wrist is fractured?

The broken wrist has some typical presentations:

  • pain and tenderness over the fracture and worsening with gripping or moving the wrist 
  • swelling
  • bruising
  • obvious deformity
  • sometimes tingling or numbness in the fingers

Sometimes these symptoms are not all present so it is wise to have your wrist checked by a doctor if you had a fall on an outstretched hand and experience weakness and pain in the hand or wrist.

People of all ages can fracture their wrist and the typical causes are falling of a bicycle, slipping on wet floor or ice, road traffic accidents, sports injuries. The risk of fracturing the wrist is much higher if you suffer osteoporosis and it is more common in women over 50years of age.

 

What are the types of distal radius fracture?

There 3 main types of distal radius fracture are:

Colles' fracture happens usually after a fall on outstretched hand with the wrist bent up as you fall - you land on your palm. 

Smith's fracture  is sometimes called reversed Colles' fracture and it happens after a fall on outstretched hand with the wrist bend down - you land at the  back of your hand.

Barton's fracture happens when in addition to the break of the bone there is also a dislocation.

Any of these fractures can be either:

  • non-displaced - the bone is broken but it hasn't moved out of place
  • displaced - the  bone broke and one part has moved 
  • comminuted or shattered  - the broken bones fracture into more than three separate pieces
  • open - when the bone breaks and pierces skin

The fractures are usually confirmed with X-ray and a CT scan might be needed if the fracture happen during a high impact.

 

What is the usual treatment for broken wrist?

The first step of the treatment for wrist fracture is immobilisation. The broken bones need to stay still in order to "knit back" together and heal properly. Depending on the type of fracture this can be achieved by:

  • splinting or casting - your wrist and forearm are placed into a splint or cast for 3-6 weeks to stabilise the broken bone and allow it to heal. This straight forward option is only possible if you had non-displaced fracture. Once the bone is healed you will start rehabilitation.
  • closed reduction and casting or splinting - if you had a displaced fracture ( your bone is out of place) the bone fragments have to be realigned; the doctor moves the bones back in place and usually puts a splint on for the first few days to allow the swelling to go down before putting a cast (plaster) on for 6 weeks. You will be usually called for weekly check ups and X-rays for the first 3 weeks to make sure the cast still fits and the healing is coming along. After 6 weeks if the bone is healed the cast is taken off and replaced by a removable splint and rehabilitation is started.
  • surgery - ORIF (Open Reduction and Internal Fixation)  - if the bones can't be realigned with closed reduction you will need surgery to make sure the bones heal in correct position to prevent deformity and poor function. The surgeon will realign and stabilise  the bone fragments using metal pins, plates and screws or external fixators. The rehabilitation will start usually straight after the surgery  depending on the surgeon and their post-surgery protocol.

 

What is the rehabilitation after broken wrist?

Regardless whether you had surgery or not you will need to engage in  rehabilitation. After few weeks of immobilisation in the cast and after the time needed for the bone to heal after the surgery your hand and wrist will be stiff, less mobile and weak. It is very important to attend experienced therapist who is familiar with the radial distal fracture rehabilitation protocol to get your wrist and hand back to full capacity gradually and safely.

The rehabilitation protocols may vary depending on the surgeon. Generally the aims of the rehabilitation will be reduction of pain, reduction of swelling, gradual increase of range of motion, strength and loading. It is also quite common to experience issues with your elbow, shoulder or neck which should be also addressed as part of your rehab.

In the Perfect Therapy clinic we work closely with your surgeon and follow whichever protocol is recommended. As part of your rehabilitation we will be most likely doing :

  • hydrotherapy - to reduce the swelling, stiffness and pain
  • myofascial release and soft tissue techniques - to reduce stiffness and increase range of motion in the hand and wrist but also elbow, shoulder and neck if needed
  • gentle mobilisation of the wrist bones and fingers
  • post isometric relaxation (PIR) techniques and antigravity relaxation (AGR) techniques to increase range of movement
  • use of thermal agents - ice to decrease the swelling at the start, heat to loosen the soft tissues later on 
  • home exercise program - exercises for you to continue at home between the physio sessions aimed at increasing range of movement and strength
  • scar therapy - if you had a surgery 
  • functional re-education - helping you to return to work or specific sporting or leisure activity following your injury