Anatomy of the Forearm
Types of Fractures
Colles Fracture
In a Colles fracture, the broken end of the radius tilts backwards. It is a more common injury.
Smith Fracture
A smith fracture is the opposite of the Colles fracture. In a Smith fracture, the broken bone tilts forward, in the direction of the palm. Smith fractures are often more unstable than Colles fractures and more often require surgery.
Treatments
Conservative Treatment
First, the doctor will reduce the fracture, meaning they will realign the broken bones to their proper place. They will then immobilize them using splints for up to a week to allow the swelling to reduce. They, or an orthopedic surgeon, will then remove the splint and cast the limb. The cast is changed about 2-3 weeks later and finally removed at around 6 weeks after the injury. The American Academy of Orthopaedic Surgeons recommends weekly X-rays for the first 3 weeks after reduction and immobilization and another radiograph before removal of the cast.
Surgical Treatments
If a patient needs surgery, you will need to see an orthopedic surgeon. The details of the surgery depend on the injury, including the fracture pattern, the associated symptoms, and the degrees at which the bones are displaced. The surgical treatment of the two common FOOSH injuries is detailed below.
Kirshner-Wire Fixation
Kirshner-wire, otherwise known as K-wire, fixation is better than plaster cast alone at stabilizing an unstable fracture. In this method, K-wire is used in addition to stabilizing the fracture. While it yields better stabilization, K-wire fixation also presents risks for infection and nerve injuries. This is not a common method of treatment anymore.
External fixation
External fixation can serve as a bridging method to definitive treatment or a non-bridging method, meaning it can be the sole intended treatment. When used as the sole treatment, patients were 6x more likely to experience mal-union. This treatment is typically reserved only for injuries too severe for open surgery.
Open Reduction Internal Fixation (ORIF)
ORIF is the surgical approach. Surgeons use dorsal or volar plates, meaning metal plates based on the internal surface of the back of the hand or the palm of the hand. The volar plates are more popular because they have a lower incidence of tendon complications. ORIF has better outcomes for unstable fractures, but does have risks for infection and tendon injury.
Conclusion
Frequently Asked Questions about Broken Wrists (FAQ)
Time is important. Please allow enough time for the bone to mend. Once your bone is mended, you can begin moving your hand to start working on regaining your motion. Other things you can do include: nicotine avoidance, eat a balanced diet and consider calcium supplements.
It is often hard to sleep the first night after your wrist is broken. Try to put several pillows underneath your arm to keep it elevated. Elevation of the wrist above your heart will minimize how much blood flows to your heart, and minimize the pain.
Usually, we encourage our patients to move their fingers with a broken wrist. If your injury is too severe, your doctor will explain your limitations to you.
It can take 2-3 months for your fractured bone to heal and often will take several months for the soft tissues and tendons to heal. Some patients require 6 months to a year of recovery.
Depending on the severity of your break you may have different abilities to move your hand. Most patients who have a fractured wrist have significant difficulty moving their wrist or hand because of pain.
After an injury, you may notice severe pain, deformity, swelling, or pain with any movement of your wrist. We have an x-ray available in the clinic if you would like us to evaluate you for a broken wrist.
First, try to elevate your wrist above your heart. Swelling can exacerbate your pain. You may try to ice your wrist. If the pain seems to be getting worse, your cast or splint may be too tight. Please call the office to be evaluated. If you need emergency treatment, please go to your nearest emergency department.
Call our office at (808) 548-7033 and we will get you seen right away. We prioritize our patients who need to get urgent treatment.
