The wrist is made up of eight small bones and the two forearm bones, the radius and ulna. The bones come together to form multiple large and small joints. The shape and design of these joints allow the wrist to bend and straighten, move side-to-side, and rotate, as in twisting the palm up or down.
A wrist fracture may occur in any of these bones when enough force is applied to the wrist, such as when falling down onto an outstretched hand. Severe injuries may occur from a more forceful injury, such as a car accident or a fall off a roof or ladder. Osteoporosis, a common condition in which the bone becomes thinner and more brittle, may make one more susceptible to getting a wrist fracture with a simple fall. Many people think that a fracture is different from a break, but they are the same.
When the wrist bone is broken, there is pain, swelling, and decreased use of the hand and wrist. Often the wrist appears crooked and deformed. Some wrist fractures may be simple with one or two large bone pieces that are well aligned and stable. Others are unstable, which implies that the bone fragments tend to displace or shift. Some wrist fractures break the normally smooth, ball bearing-like joint surface, while others will be near the joint but leave the joint surface intact. Sometimes the bone is shattered into many pieces, which usually makes it unstable. An open (compound) wrist fracture occurs when a bone fragment breaks through the skin.
Examination and x-rays are needed so that Dr. Pianka can tell if there is a fracture and assess the position of the bones, in order to help determine the treatment. Occasionally a CT scan may be helpful to get better detail of the fracture fragments. In addition to the bone, ligaments (the structures that hold the bones together), tendons, muscles, and nerves may be injured as well when the wrist is broken. These injuries may need to be treated in addition to the fracture. Whenever the bone protrudes through the skin, it is important to receive immediate care to minimize the risk of infection. When numbness in the fingers is present, it implies that nerves have been injured.
To treat a fracture that has been set or is not displaced, a splint or cast can be used. Usually a cast is worn for several weeks depending on each patient’s fracture and ability to heal the broken bone.
Some fractures may need surgery to properly set the bone and/or to stabilize it. Fractures may be stabilized with pins, screws, plates, and rods. Plates and screws that can be placed through an incision on the bottom or top of the wrist are often used to hold the bone fragments in place and may allow early use of the hand and wrist. These implants are buried inside the wrist and usually do not require removal.
While traditional surgery requires an open incision, Dr. Pianka is able to treat many patients suffering from certain types of wrist fractures through minimally invasive arthroscopic surgery. In this outpatient procedure, he can examine and repair the damage of the interior of a joint using a thin arthroscope that is introduced into the joint space through several tiny incisions. Because the incisions used with wrist arthroscopy are smaller and disrupt less soft tissue than conventional open surgery, pain, swelling and stiffness are minimized and recovery is often faster.
While the wrist fracture is healing, it is very important to keep the fingers and shoulder flexible, provided that there are no other injuries that would require that they be immobilized. Once the wrist has enough stability, motion exercises may be started for the wrist itself. Dr. Pianka will determine the appropriate timing for these exercises. Hand therapy is often used to help recover flexibility, strength, and function. It is not unusual for maximal recovery from a wrist fracture to take several months.