wrist fracture

Wrist fracture: description

Wrist fracture (distal radius fracture) refers to a fracture of the radius (radius) up to three centimeters away from the wrist. Three quarters of all patients have a simple spoke fracture. In the last quarter, joint surfaces are also affected by the injury, which can hinder healing.

The wrist fracture accounts for about 25 percent of all fractures in adults, making it the most common form of fracture. Mostly affected are people over the age of 50, and especially women. In the under-50s age group, slightly more men than women suffer wrist fractures.

Greenstick fracture

In adolescents, special forms of bone fracture occur because the bones are still very elastic at this age. One of these special forms is the greenwood fracture – an incomplete fracture in which the outer layer of the bone (cortical bone) is still partially intact. At this point, the broken ends are still “stuck” to each other. The green wood fracture occurs especially in long bones. Thus, the distal radius fracture (wrist fracture) in children and adolescents may also be expressed as a greenwood fracture – the spoke is not completely broken.

Wrist fracture: symptoms

A wrist fracture causes pain, especially if you turn the affected hand outwards or turn your forearm. Other possible symptoms include visible deformity, swelling and emotional disorders. The affected hand loses strength and can no longer fulfill its full function.

Wrist fracture: causes and risk factors

The cause of a wrist fracture is in most cases a fall that one tries to catch by hand. As a rule, you first land on the floor with the palm of your hand, which results in a so-called extension fracture (“Colles fracture”): the hand is stretched on impact, the wrist-like bone fragment is displaced towards the back of the hand.

Rarely is the hand geflext on impact, so you come up with the back of the hand first. This results in a flexion fracture (“Smith fracture”): The wrist-like bone fragment shifts toward the palm of the hand.

The distal radius fracture occurs mainly in the elderly, because their bones have lost their strength due to wear and usually also due to osteoporosis (bone loss). In addition, the elderly are often more insecure and frail, less agile, and less able to absorb falls. Then a fall from a standing position is often sufficient, for example in your own home or on the sidewalk for a broken wrist. Factors that increase the risk of falls (such as gait insecurity, blurred vision, circulatory problems, cardiac arrhythmia) also increase the risk of falling due to fracture of the wrist.

In younger people with their more stable bones, on the other hand, more force is needed for such a bone fracture – a dangerous fall, a traffic or sports accident.

Wrist fracture: examinations and diagnosis

If you suspect that your wrist is broken, you should consult a doctor for orthopedics and traumatology. He will ask you first about your complaints and the course of the accident (anamnesis). Possible questions are:

• Did you fall on the wrist?
• How exactly did the accident happen?
• Can you still stretch and bend the wrist?
• Do you have pain?
• Have you ever had any discomfort in the hand such as pain, restricted movement or a previous dislocation?
• Do you have any pre-existing conditions such as osteoporosis or osteoarthritis?

After that, the doctor will examine your wrist closely: He will check if there is a malposition and if careful scanning of different places causes pressure pain. He looks for soft tissue injuries such as abrasions, bruises or hematomas (bruises) and any accompanying injuries (such as on the ligaments and bones of the hand, on the arm and on the shoulder). He also checks the sensitivity and blood flow of the hand. Also important is a functional test: The doctor tests whether the hand and finger joints move actively and passively and let the forearm turn.

Wrist fracture: imaging procedures

Anamnesis interview and examination often already give a strong suspicion of a wrist fracture. To secure the diagnosis, the wrist is x-rayed in two levels. X-ray examination is the standard method for clarifying a distal radius fracture.

Sometimes a computed tomography (CT) can be useful, for example, if additional injuries in the carpal region are suspected.

In some cases – if there is a suspicion that ligaments or cartilage have also been injured – MRI (magnetic resonance imaging, MRI) is performed.

By way of exception, further examinations may also be ordered, for example an ultrasound examination (sonography).

Wrist fracture: treatment

Treatment for a wrist fracture aims to relieve the pain and restore the function, mobility, and strength in the wrist and hand as quickly as possible. For pain relief, the patient receives medication (analgesics). The other therapeutic measures depend on the type of fracture, any comorbidities and the age and general condition of the patient. In principle, a wrist fracture can be treated conservatively and surgically.

Wrist fracture: Conservative treatment

For a conservative treatment, one decides in an uncomplicated wrist fracture – ie a fracture in which no articular surfaces are involved and which is not or only slightly shifted. Such a fracture can easily be correctly anatomically aligned (repositioned). Even a greenwood fracture in adolescents is usually treated conservatively.

Patients will receive a casting bandage (gypsum or softcast) for four to five weeks. The healing process is monitored by x-rays after four, seven and 11 days.

Wrist fracture: surgical treatment

A complicated wrist fracture needs surgery. Physicians describe the following fractures as “complicated”:

• Wrist fracture involving the joint
• Fracture, which strongly diverges at the fracture gap
• open wrist fracture (broken bones stick out through the skin)
• Wrist fracture with major soft tissue damage and / or additional nerve or vascular damage
• Wrist fracture with complex accompanying injuries (such as damage to adjacent ligaments)
• Wrist fracture in existing osteoporosis
• Wrist fracture, which was not successfully restored to the correct anatomical position by conservative measures

The standard surgical procedure for a wrist fracture is the so-called osteosynthesis with an angle-stable plate: With the help of this metal plate, the fracture is correctly aligned and stabilized again. Then the wrist is immobilized for a while – for how long, it depends on the stability that could be achieved by the operation. Immediately after the operation and after eight weeks, the fracture is checked in an x-ray.

Wrist fracture: aftercare

The wrist fracture itself is sedated for a long time, both conservatively and surgically. However, the adjacent joints (fingers, elbows, shoulders) and the arm should be moved early: A physiotherapist shows the patient appropriate movement exercises. Also in everyday life, the fingers (in spite of bandage or plaster on the wrist) should be moved and used as normally as possible, for example to grasp.

To avoid swelling, do not let the arm hang down and store it on a pillow at night.

The plate implant used in the operation will be removed after 12 months at the earliest. The exact time depends on individual factors such as local complaints and the age of the patient.

Wrist fracture: disease course and prognosis

A wrist fracture often heals easily, especially with stable fractures. In some cases, however, complications and long-term consequences develop:

• limited mobility of the wrist and fingers
• Reduction of the strength of the wrist and fingers
• Deformations of the wrist, deformities
• Movement and / or emotional disorders in nerve injuries
• Circulatory disorders in vascular injuries
• delayed tipping of the fracture (the bone fragments move and twist after treatment attempt)
• Healing is delayed or delayed, so that the fracture does not ossify but a “false joint” develops (pseudarthrosis)
• Osteoarthritis when the wrist is involved in the fracture
• Carpal Tunnel Syndrome
• chronic pain
• Shoulder pain due to poor posture of the arm
• Complex regional pain syndrome (CRPS, also called Sudeck’s disease)
• Tear of the long thumbstrike tendon
• Implant relaxes or wanders

Patients after a wrist fracture suffering from persistent or increasing pain or emotional disorders, should immediately go to the doctor so that possible complications are detected early.