I Broke My Wrist
“I Broke My Wrist!” What Does This Mean?
Often in therapy we hear patients state, “I broke my wrist”. What exactly does that mean? In this article we will try to explain how to to diagnose and treat a broken wrist.
Overview of a Broken Wrist
The forearm is made up of two long bones: the radius and the ulna. The portion of the radius at the wrist level is known as the distal radius. A distal radius fracture (broken wrist) is the most commonly broken bone in the arm. The fracture usually occurs when a person falls on their outstretched hand. It can also happen in traumatic situations such a car accidents or during sports. Occasionally, the other bone in the forearm (the ulna) is also broken. When this happens, it is called a distal ulna fracture.
Symptoms & Diagnosis
A distal radius fracture usually causes immediate pain, tenderness, bruising, and swelling. Occasionally, the wrist may look out of alignment if the fracture is severe. An X-ray of the wrist will be taken to visualize the extent of the injury. The fracture almost always occurs about 1 inch from the end of the radius bone (distal portion). A fracture that extends into the joint is called an intra-articular fracture. A fracture that does not extend into the joint is called an extra-articular fracture. The word “articular” means joint.
A fracture may also be displaced or nondisplaced. A displaced fracture occurs when the distal piece shifts out of alignment and results in deformity. A non-displaced fracture is when a fracture occurs with no change in alignment of the bone. A fracture that results in the bone breaking the skin is called an open fracture. A fracture in which the bone is broken into two or more pieces is called a comminuted fracture. Intra-articular fractures (fractures within the joints), open fractures (fractures that break through the skin), displaced fractures (distal portion shifts out of alignment), and comminuted fractures (fracture that shatter the bone into a lot of small pieces) are the more difficult cases to treat.
Non-surgical Treatment
If the broken bone is in a good position/alignment, a cast or splint may be applied until the bone heals. If the alignment of your bone is not good and likely to cause a functional deficit of the wrist and hand, it may be necessary to correct the deformity. In this case, the bone would be physically re-aligned (reduced) by the doctor. If the bone is straightened (reduced) without having to open the skin (incision), this is called a closed reduction. After the bone is properly aligned, a splint or cast may be placed on your arm. The cast may be changed as the swelling goes down so the cast does not get too loose.
Follow-up X-rays may be taken to determine that the bone is staying reduced and to ensure that proper healing is taking place. During this time, the patient may receive physical or occupational therapy to improve the motion in the uninvolved joints such as the fingers. When the bone is healed (usually about 6 weeks), additional therapy may be required to improve the motion and function of the injured wrist and forearm.
Surgical Treatment
If a distal radius has poor alignment and is not able to be properly reduced, a surgical treatment is usually warranted. If left untreated, long-term pain and deformity would prevent good functioning of the arm. There are many surgical options when dealing with a more complex distal radius fracture.
1. Percutaneous pinning (a pin inserted through the skin) may be used after the fracture is reduced to provide additional stability to the reduced fragments.
2. External fixation may be used to stabilize the unstable boney structure. In this kind of reduction, holes are drilled into uninjured areas of bones around the fracture and special bolts or wires are screwed into the holes. Outside the arm, a rod or a curved piece of metal with special ball-and-socket joints joins the bolts to make a rigid support. The fracture can be set in the proper alignment by adjusting the ball-and-socket joints. Since the bolts penetrate the skin, proper cleaning to prevent infection at the site of surgery must be performed.
3. Open reduction Internal Fixation (ORIF) may be used in which screws and/or plates are used to stabilize the fracture. Some surgeons use titanium bone plates, screws, and intramedullar nails to rigidly fix fracture.
After Surgery
In the early phases, ice, elevation (holding their arm up above their heart), compression garments to decrease swelling (ace wraps, isotoner gloves) and medications for pain relief are usually recommended. Due to the fracture being stabilized by the surgical hardware, therapy may be recommended days after surgery. Your physical or occupational therapist may work with you on pin care, custom splinting, swelling control, pain control, increasing mobility of the fingers, wrist, forearm, elbow, shoulder and neck and eventually strengthening when the fracture is healed enough.
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