Wrist Injuries & Fractures

The wrist is comprised of two bones in the forearm, the radius and ulna, and eight tiny carpal bones in the palm. The bones meet to form multiple large and small joints. A wrist fracture refers to a break in one or more of these bones.

Types of wrist fracture include:

• Simple wrist fractures in which the fractured pieces of bone are well aligned and stable.
• Unstable fractures are those in which fragments of the broken bone are misaligned and displaced.
• Open (compound) wrist fractures are severe fractures in which the broken bones cut through the skin. This type of fracture is more prone to infection and requires immediate medical attention.

Causes

Wrist fractures may be caused due to fall on an outstretched arm, vehicular accidents or workplace injuries. Certain sports such as football, snowboarding, or soccer may also be a cause of wrist fractures. Wrist fractures are more common in people with osteoporosis, a condition marked by brittleness of the bones.

Signs and Symptoms

Common symptoms of a wrist fracture include severe pain, swelling, and limited movement of the hand and wrist. Other symptoms include:

• Deformed or crooked wrist
• Bruising
• Numbness
• Stiffness

Diagnosis

Your doctor performs a preliminary physical examination followed by imaging tests such as an X-ray of the wrist to diagnose a fracture and check alignment of the bones. Sometimes a CT scan may be ordered to gather more detail of the fracture, such as soft tissue, nerves or blood vessel injury. MRI may be performed to identify tiny fractures and ligament injuries.

Your doctor will order a bone scan to identify stress fractures due to repeated trauma. The radioactive substance injected into the blood gets collected in areas where the bone is healing and is detected with a scanner.

Treatment

Your doctor may prescribe analgesics and anti-inflammatory medications to relieve pain and inflammation.

Fractures that are not displaced are treated with either a splint or a cast to hold the wrist in place.

If the wrist bones are displaced, your surgeon may perform fracture reduction to align the bones. This is performed under local anesthesia. A splint or a cast is then placed to support the wrist and allow healing.

Surgery

Surgery is recommended to treat severely displaced wrist fractures and is carried out under the effect of general anesthesia.

External fixation, such as pins may be used to treat the fracture from the outside. These pins are fixed above and below the fracture site and are held in place by an external frame outside the wrist.

Internal fixation may be recommended to maintain the bones in proper position while they heal. Devices such as rods, plates and screws may be implanted at the fracture site.

Crushed or missing bone may be treated by using bone grafts taken from another part of your body, bone bank or using a bone graft substitute.

During the healing period, you may be asked to perform some motion exercises to keep your wrist flexible. Your doctor may recommend hand rehabilitation therapy or physical therapy to improve function, strength and reduce stiffness.

Risks and Complications

As with any procedure, wrist fracture surgery involves certain risks and complications. They include:

• Infection
• Residual joint stiffness
• Arthritis

Injuries caused due to stretching or tearing of the ligaments in the wrist are called wrist sprains. These injuries are usually caused by a fall during daily activities or sports activities. Sprains can range from mild to severe based on the extent of injury to the ligament. Some of the main symptoms of wrist sprains include:

• Swelling and pain in the wrist
• Difficulty in moving your wrist
• Bruising around the wrist
• Popping sensation inside the wrist
• A feeling of warmth or feverishness in the wrist

Your doctor diagnoses this condition with the help of your medical history and physical examination of your wrist. Your doctor may also use imaging tests such as X-rays, CT scans and MRI to diagnose partial ligament tears.

Treatment for wrist sprains includes surgical and non-surgical treatments. Non-surgical treatment involves immobilization of the wrist and performing strengthening exercises once the pain has reduced. Surgical treatment is used to repair the ligament if it is completely torn.

The scaphoid bone is a small, boat-shaped bone in the wrist, which, along with 7 other bones, forms the wrist joint.   It is present on the thumb side of the wrist causing it to be at a high risk for fractures. A scaphoid fracture is usually seen in young men aged 20 to 30 years. They can occur at two places: near the thumb or near the forearm.

Causes

Scaphoid fracture occurs due to a fall on an outstretched hand with complete weight falling on the palm. This fracture usually occurs during motor accidents or sports activities.

Symptoms

Symptoms of a scaphoid fracture include pain and swelling at the site of injury (base of the thumb and forearm). There is usually no deformity at the site of fracture, hence it may be mistaken for just a sprain. Bruising is also a very rare symptom of the fracture. There are chances that the patient might not be aware of the fracture for months or even years after the fall as the pain generally improves in a few days.

Diagnosis

Scaphoid fractures are diagnosed by X-rays; however, a non-displaced fracture does not show up on an X-ray when it is taken as early as the first week. Hence, your doctor will test for tenderness at the site of the scaphoid bone to detect the fracture. Your doctor will also advise you to use a splint and avoid lifting anything heavy for a few weeks and then order another X-ray to check for visibility of the fracture. Sometimes, an MRI scan, CT scan or bone scan can also be ordered to confirm the diagnosis of the scaphoid fracture.

Treatment

Treatment for scaphoid fracture is based on the site of the fracture i.e. the fracture near the thumb or near the forearm.

Non-surgical Treatment: Your doctor will suggest non-surgical treatment when the scaphoid fracture is not displaced. Non-surgical treatment involves immobilization of the forearm, hand and/or thumb in a cast. It might also include the elbow in case of fractures near the forearm. The time taken for the fracture to heal ranges from 6 – 10 weeks. Fractures near the thumb take relatively less time to heal when compared to fractures near the forearm as the blood supply necessary for healing is better near the thumb.

Surgical Treatment: Surgical treatment may be suggested when the fracture is displaced or is present closer to the forearm. In surgical treatment, an incision is made either in the front or back of the wrist. Your surgeon will use screws and wires to hold the scaphoid bone in place as it heals. If the bone is broken into more than 2 pieces, bone graft (graft usually taken from the forearm or hip) may be used to help in the healing process.

Following surgery, your hand will be placed in a splint or cast until it completely heals. Until then, you will be advised by your doctor to avoid contact sports and not to lift, throw, push or pull heavy weights with the injured arm. During recovery, you will be given physical therapy and taught certain exercises to help you regain strength and range of motion in your wrist.

Complications

The complications involved in the treatment of scaphoid fracture include:

• Non-union: when a bone fails to heal after treatment. This is caused due to limited blood supply in the scaphoid region. A special kind of bone graft called a vascularized graft, in which the bone has its own blood vessels, can be used to overcome this complication.
• Avascular necrosis: This is a complication in which cells of the scaphoid bone die due to lack of blood supply, causing bone collapse and arthritis. This usually happens in case of displaced fractures, as the displaced bone fails to get proper nutrients. Treatment with a vascularized graft will be suggested by your doctor to treat this complication.
• Post-traumatic arthritis: Persistent non-union and avascular necrosis of the scaphoid can cause arthritis of the wrist. This can be treated with splits, anti-inflammatory medications, steroid injections or surgery.

Conclusion

Scaphoid fractures can prove to be a permanent disability if not treated appropriately and with full care. The patient must take proper care to wear the cast until complete recovery of the fracture has occurred. It is also very important to maintain complete motion of the fingers and avoid lifting or pushing heavy weights during the recovery period. Exercise programs and physical therapy prescribed by the doctor should be strictly followed until the same motion and strength in the wrist is restored.