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Wrist Fracture / Broken Wrist

Definition:
If you think you've sustained a broken wrist or a broken hand, seek prompt medical attention. It's important to treat a broken wrist or broken hand as soon as possible. Otherwise, the bones may not heal in proper alignment, which can affect your ability to perform everyday activities, such as grasping a pen or buttoning a shirt.

Treatment for a broken wrist or a broken hand depends on the exact site and severity of the injury. A simple break (fracture) may be treated with a splint, ice and rest. However, a more complicated broken wrist or broken hand may require surgery to realign the broken bone and to implant wires, plates, rods or screws into the broken bone to maintain proper alignment during healing.

Causes:
The terms "broken wrist" and "broken hand" are used to describe a range of fractures in this area of your body:

Causes of a broken wrist
Your wrist is made up of eight small hand bones (carpal bones) plus two long bones in your forearm — the radius, on the thumb side of your arm, and the ulna, on the pinky side of your arm. Together, these bones allow your wrist

to bend, straighten and rotate, so you can bang a hammer, pitch a ball or swing a jump-rope.

It's possible to break any of the bones that make up your wrist, but the radius is the most commonly broken wrist bone. This type of fracture, often called a distal radius fracture or Colles' fracture, usually occurs when you fall forward onto an outstretched hand, during a bike accident, ski accident or fall from a roof or ladder. It can also happen during a car collision. Fractures of the ulna bone also are common and also occur from a direct blow to your arm.

The most commonly injured carpal bone is the scaphoid bone — which is the carpal bone located near the base of your thumb. Scaphoid fractures usually occur during a fall, but can result from a blunt blow to your wrist.

Causes of a broken hand
There are a lot of bones to break in your hands: Each finger consists of one hand bone (metacarpal) and three finger bones (phalanges). Each thumb consists of one metacarpal bone and two phalanges. Any of these bones can break during a fall, a direct blow or a crushing injury.

It's also common for hand bones to be injured during sports activities. For proof, you don't have to look any further than the names of fractures in this part of your body: There's the "boxer's fracture," a punching injury that usually affects the metacarpal bone leading to your little finger. Other common injuries include the "skier's thumb" and the "baseball finger."


Risk Factor:
These factors may put you at risk of a broken wrist or broken han:
  • Participating in certain sports activities. Contact sports, such as basketball, football rugby, wrestling and hockey, are common causes of a broken wrist or broken hand. Recently, more wrist and hand fractures are due to adventure sports, such as snowboarding and skiing.
  • Having certain health conditions. Osteoporosis, bone disease and calcium deficiency may make you more susceptible to a broken wrist or broken hand.
When to seek medical advice:
See your doctor if you have any signs or symptoms of a broken wrist or broken hand, including numbness, swelling or trouble moving your fingers. Delays in diagnosis and treatment can lead to poor healing, decreased range of motion and decreased grip strength.

Seek emergency medical attention if your hand or wrist is very painful or severely deformed. Also seek urgent evaluation of your hand or wrist if you see any skin cut or laceration with bone protruding through the skin near your injury. An exposed bone can lead to a severe infection if not treated promptly.

Symptoms:
If you have a broken wrist or broken hand, you may experience these signs and Symptoms:
  • Severe pain, which may increase during gripping or squeezing
  • Swelling
  • Tenderness
  • Bruising
  • Obvious deformity, such as a bent wrist or crooked finger
  • Stiffness or inability to move your finger or thumb
  • Numbness or coldness in your finger or thumb
Diagnosis:
If you suspect that you have a broken wrist or broken hand, your doctor will inspect the affected area for tenderness, swelling, deformity or an open wound.

He or she may also do some maneuvers to measure your range of motion and grip strength, compared with your healthy hand. Plus, you'll need X-rays — and sometimes more-detailed images from a computerized tomography (CT) scan or magnetic resonance imaging scan (MRI) — to definitively diagnose a fracture or ligament injury and pinpoint the exact location of any break.

A thorough evaluation of your injury also helps your doctor classify your fracture into one of the following categories, which helps determine your Treatment:

  • Closed fracture. The bone is broken, but the surrounding skin remains intact. In general, a closed fracture is the least severe type of fracture.
  • Open or compound fracture. The bone is broken, and the skin is pierced or cut by the broken bone. An open fracture is a serious condition that requires immediate, aggressive treatment to decrease your chance of an infection.
  • Displaced fracture. In this fracture, the bone fragments on each side of the break are not aligned. A displaced fracture may require surgery to realign the bones properly.
  • Comminuted fracture. The bone is broken into more than two pieces. This type of fracture may also require surgery for complete healing.
Complications:
Complications of a broken wrist or broken hand are rare, but may include:
  • Ongoing stiffness, aching or disability. You may experience ongoing stiffness, pain or aching in the affected area even after your broken bone has healed. This generally goes away a month or two after your cast is taken off or after surgery, but you may have some permanent stiffness or aching if your injury was severe. It may also take a few months to regain your ability to use your hand and fingers normally. Be patient with your recovery, and talk to your doctor about hand exercises that might help.
  • Osteoarthritis. Fractures that extend into the joint can cause arthritis years later. If your wrist or hand starts to hurt or swell long after a break, see your doctor for an evaluation.
  • Poor healing. Some hand or wrist fractures — such as scaphoid fractures — may be tougher to heal because of poor blood supply to this area of your body. Smoking cigarettes is also a risk factor for poor healing of fractures. If you smoke, consider stopping to give yourself the best chance of healing.
  • Bone infection (osteomyelitis). If you have an open fracture, your bone may be exposed to fungi and bacteria that can cause infection. Prompt treatment of an open fracture is critical.
  • Nerve or blood vessel damage. Trauma to the wrist or hand can injure adjacent nerves and blood vessels. Seek immediate attention if you notice any numbness or circulation problems.
  • Compartment syndrome. This neuromuscular condition causes pain, swelling and sometimes disability in affected muscles of the legs or arms. This is a rare complication of high-impact injuries, such as a car or motorcycle accident.
Treatment:
Initial treatment for a broken wrist or broken hand often begins in an emergency room or urgent-care clinic. Here, doctors typically evaluate your injury and immobilize your wrist or hand with a splint.
  • If you have a displaced fracture, your doctor may need to manipulate the pieces back into their proper positions before applying a splint — a process called reduction. Depending on the amount of pain and swelling you have, you may need a muscle relaxant, a sedative or even a general anesthetic before this procedure.
  • If you have a closed fracture, you'll probably be sent home with the splint and directions to rest and ice the injury until you see your regular doctor or an orthopedic specialist for further treatment in a few days.
  • If you have a more serious fracture, you may be admitted to the hospital for immediate attention.

Treatment for a broken wrist or broken hand depends on the site and severity of the injury, as well as your age and overall health, but treatment typically involves the following components:

Immobilization
Restricting the movement of a broken bone in your hand or wrist is critical to healing. This may involve splints, casts or braces for three to eight weeks, depending on your injury. Your doctor may request regular X-rays throughout the healing process to make sure the bones stay aligned.

Surgery
Immobilization heals most broken bones. However, some fractures require stabilization. You may need surgery to implant internal fixation devices, such as wires, plates, nails or screws, to maintain proper position of your bones during healing. Surgery may be recommended if you have the following injuries:
  • Multiple fractures
  • An unstable or displaced fracture
  • Loose bone fragments that could enter a joint
  • Damage to the surrounding ligaments
  • Fractures that extend into a joint
  • Open skin related to the fracture
  • A fracture that is the result of a crushing accident

Most internal fixation materials are left in place. Others may be removed after your bone heals, while some are made of materials that are absorbed into your body. Complications are rare, but can include wound-healing difficulties, infection and lack of bone healing.

One of the biggest advancements in treatment for wrist fractures is the palm-side (volar) approach to surgery for distal radius fractures. In this treatment, a surgeon enters your skin from the palm side and screws a plate to the radius to hold the fracture in place, which allows the use of your fingers and hand while the fracture heals. The newer approach may disturb less soft tissue and lead to a faster recovery. If you have a distal radius fracture, ask your doctor if this newer surgery is a good option for you.

For some injuries, your doctor may also recommend an external fixation device — a set of metal bars outside your skin, which is attached to pins that go through your skin and insert into bone. This device provides stability during healing. It's usually removed after about six to eight weeks. And there is a risk of infection around the surgical pins connected to the external fixation device.

Medications
To reduce pain and inflammation, your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) or a combination of the two. If you're experiencing severe pain, you may need an opioid medication, such as codeine, for a few days.

Ask your doctor before you take any medications. For some fractures, you may need to avoid ibuprofen. Some studies have suggested that nonsteroidal anti-inflammatory drugs, such as ibuprofen, may slow down healing.

Rehabilitation
Rehabilitation begins soon after initial treatment. In most cases, it's important to begin some motion to minimize stiffness in your hand while you're still wearing your cast.

After your cast or splint is removed, your doctor may recommend additional rehabilitation exercises or physical therapy to reduce stiffness and restore movement in the injured area. It can take several months to regain full use of your hand or finger, depending on the severity of the injury.

Prevention:
It's impossible to prevent the unforeseen events that often cause a broken wrist or broken hand. But these basic tips may offer some protection:
  • Build bone strength. Calcium-rich foods, such as milk, yogurt and cheese, can help build strong bones. In general, a regular diet with the recommended calcium intake is best, even after a fracture. For women, the recommended amount of calcium increases with age and with menopause. Talk to your doctor about how much calcium you need.
  • Prevent falls. Falling forward onto an outstretched hand is the No. 1 cause of a broken hand or broken wrist. To prevent this common injury, wear sensible shoes. Remove home hazards. Light up your living space. And install grab bars in your bathroom and handrails on your stairways, if necessary.
  • Use protective gear for athletic activities. Wear wrist guards for high-risk activities, such as in-line skating, snowboarding, rugby and football.
  • Ease into adventure sports. As snowboarding and in-line skating become more popular, so do hand and wrist injuries associated with these sports. If you want to try snowboarding or other adventure sports, consider professional instruction and know your limits.
 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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