The wrist is the area between the hand and forearm (radius and ulna), and is made up of a number of bones and joints. The radius is the larger bone of the two forearm bones, and a typical wrist fracture is a break of the radius. A fracture can range from a hairline crack through to complete displacement of the bone, or even fractures in multiple pieces. The ulna is the smaller of the two forearm bones, and is sometimes fractured as well.
Sprains occur where ligaments are overstretched or damaged. Ligaments are tough fibrous tissue connecting bones together to help hold them in place. Wrist sprains refer to over stretching or damage to the ligaments around the wrist joint. These are graded on severity with grade 1 being a mild stretching with no tear through to grade 3 that results in the ligaments being completely torn.
Wrist fractures or sprains are most often caused by:
- Fall onto an outstretched hand
- Sporting accidents
- Fall from pushbikes or motorbikes
- Car accidents
The syptoms of wrist fractures include:
- Swelling and brushing
- Damage to the nerves resulting in numbness or tingling
Your doctor will ask you questions about the nature of your injury and symptoms. An examination of your wrist will assist diagnosis. A fracture of the wrist will be confirmed with an x-ray. A fracture that cannot be clearly seen on x-ray may require a CT (computed tomography) scan to provide further detail. At times, an MRI scan may also be necessary either to assess ligament damage or give more information on the state of the bones.
In the case of minor sprains the treatment generally consists of:
- Rest – immobilise the limb with a splint or sling
- Ice – apply ice in 20-minute intervals taking care not to apply ice directly to the skin.
- Compression – light compression may provide support and help reduce swelling
- Elevate – to help reduce swelling
Once the pain has improved a physiotherapy program can commence. If the pain and swelling does not subside, or you experience numbness or tingling in your fingers you should seek early medical advice.
In the case of a wrist fracture the surgeon will determine whether surgery is required depending on the position of the bony fragments. When the bones are not aligned or the broken part of the bone has pierced the skin, surgery will be required to realign the bones. The bones are most commonly fixed in place with metal plates and screws and your arm will be immobilised in a cast or splint. for up to 6 weeks depending on the fracture type and surgery. You may also need a course of physiotherapy.
Following a wrist fracture, there is a risk of the following complications:
- Malunion (the bones heal in an abnormal position)
- Infection and wound breakdown
- Damage to blood vessels or nerves
- Decreased function and stiffness
- Ongoing pain
- Prominence of the metal work, may require removal
- Failure of fixation – sometimes the bones are not strong enough to be held together with plates, screws or wires. This will often require further surgery
- Nonunion – non-healing of the bone. Factors increasing the risk of nonunion include: