Queen's Medical Center POB1, 1380 Lusitana Street, Suite 808, Honolulu, HI 96813
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Distal Radius Fracture

Is my wrist Broken or Sprained?

Fell and hurt your wrist? Do you want to figure out if you broke your wrist, or just had a sprain? Read below to find out more.

A distal radius fracture, commonly referred to as a broken wrist, accounts for about 16% of fractures treated in emergency departments throughout the United States. A distal radius fracture can occur in many different patient populations, including the young and athletic or elderly and sedentary. These common fractures can be treated differently depending on certain injury characteristics. An orthopedic surgeon is an expert on determining which injuries necessitate which treatments.

Anatomy of the Forearm

The forearm is composed of two bones, the radius and the ulna. The radius is the larger of the two bones while the ulna is thinner. They both run the length of the entire forearm, forming the elbow when they meet the humerus, the upper arm bone. The distal radius refers to the end of the radius near the wrist, whereas the word ‘proximal’ refers to the portion of the forearm closest to the elbow.

What is often referred to as the wrist is actually the point at which the ulna and the radius converge on the carpal bones, the small bones that make up the base of the hand. The radius articulates with the carpal bones on the same side as the thumb. The ulna meets the carpal bones on the side of the pinky finger.

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

Certain distal radius fractures can be treated easily in the emergency department with conservative treatment. Other fracture patterns, however, necessitate an orthopedic surgeon. Open fractures, fractures with associated neurovascular compromise, or unstable fractures will often require surgery. Additionally, fractures that are significantly displaced require surgery. The options for conservative treatment and surgery are below.

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 of 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

Anyone can suffer from a distal radius fracture. Fractures in the young are often due to sporting injuries or high-speed trauma, while fractures in the elderly can be associated with something as simple as a ground-level fall. Treatment can range from splinting and casting to surgery. The treatment options depend on the severity of the injury. An orthopedic surgeon is the best physician to manage a distal radius fracture. Ask Dr. Morton about your options today.

Frequently Asked Questions about Broken Wrists (FAQ)

I was seen in the emergency department or an urgent care for a broken wrist and told I need surgery. How soon can I set up an appointment?

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.

I had a cast placed and my arm hurts. My fingers look swollen. What should I do?

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.

How do I know if I broke my wrist?

After an injury you may notice severe pain, deformity, swelling, or pain with any movement of your wrist. We have x-ray available in the clinic if you would like us to evaluate you for a broken wrist.

Can you move your wrist if it's broken?

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.

How long does it take for a broken wrist to heal?

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.

Should I move my fingers with a broken wrist?

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.

How do you sleep with a broken wrist?

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.

What's the fastest way to heal my broken wrist?

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.

Schedule an Appointment

Meet Dr. Paul N. Morton, MD

Dr. Paul N. Morton, MD is a fellowship-trained orthopedic surgeon in hip and knee surgery, specializing in robotic joint replacements, complex joint reconstruction, sports injuries, and trauma. Reach out to him to learn more about treatment options for your problem.

Written By: Dr. Paul N. Morton, MD

 

Post Published on June 15, 2020

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