Broken Wrist

Broken Wrist

A broken wrist (or fractured wrist) is a fracture or break in the wrist end of either the radius and ulna forearm bones or any of the small carpal bones in the wrist. There are a number of different types of wrist fracture so an accurate diagnosis is essential.

Symptoms of a broken wrist

Broken wrist symptoms will vary slightly depending on the type and grade of the fracture. Sudden pain is common with rapid swelling and the wrist may appear deformed. Pain is likely to increase when trying to move the hand. If tingling or numbness are felt anywhere in the hand or fingers this may indicate nerve damage. There are a number of fractures of the wrist. Below we outline some of the more common.

If you suspect a broken wrist then medical attention should be sought immediately. An X-ray should be taken to determine the extent of the fracture and displacement of any bone fragments. A full examination of any fractured wrist will help to rule out any other associated injuries. Sometimes the bone fragment may be broken into more than one piece, known as a comminuted fracture of the wrist. If bones pierce the skin then this is known as an open fracture. Below we explain some of the more common types of wrist fracture.

Scaphoid fracture

A Scaphoid fracture is probably the most common wrist fracture and involves a fracture to one of the small carpal bones in the wrist called the scaphoid bone. The blood supply to the scaphoid is poor so complications and incomplete healing can occur. Symptoms of a scaphoid fracture include pain in the wrist at the time of injury and rapid swelling at the back of the wrist. Pain may settle down soon after the fall but the patient will have difficulty gripping things. There will be tenderness when pressing in on the wrist compared with the non injured wrist.

The exact area of tenderness is called the anatomical snuff box and is located between two tendons on the thumb side of the wrist. Compression of the thumb inwards towards the wrist causes pain. Initially treatment of a scaphoid bone fracture would be to apply ice or cold therapy, protect the wrist with bandaging or strapping and seek medical attention. Scaphoid fractures have a risk of not healing properly due to the poor blood supply. If this happens then in some cases the fracture is immobilized again for a further 4 to 6 weeks. Immobilizing beyond this time is unlikely to be beneficial so in this case surgery is often required and many surgeons would do this sooner rather than opting for a further period of immobilization.

Read more on scaphoid fractures.

Colles fracture

Broken WristA Colle's fracture is a break at the wrist end of the radius bone in the forearm. The most common cause of a Colles fracture is a fall onto an outstretched arm, particularly in older females who may be suffering from osteoperosis. Symptoms include sudden pain in the wrist with rapid swelling. There may be deformity known as a dinner fork deformity. The patient will severe pain when trying to move the wrist. In very severe cases  one end of the bone may pierce the skin which is known as an open fracture.

Due to the force which is required to fracture the distal radius (forearm bone), sometimes a fracture of the end of the Ulna (other foreaem bone) may also occur. Soft tissue injuries to the ligaments at the wrist especially are also common.

The treatment of a Colles fracture depends on the extent of the injury. A straightforward fracture with no displacement will simply require casting to immobilise the bones until they are healed. This is usually around 6 weeks. A splint may be used for the first few days to allow the swelling to go down before the cast is applied.

Hook of hamate fracture

Hook of Hamate FractureAnother type of wrist fracture is a fractured hook of hamate. This is a fracture to the hamate bone which is one of the small carpal bones on the little finger side of the wrist. Symptoms of a fracture of the hook of hamate include pain which is located on the little finger side of the wrist. The patient will have reduced grip strength and there will be tenderness when touching the palm side of the wrist.

A fracture of this part of the hamate bone in the wrist can occur from swinging a golf club, tennis racket or baseball bat particularly if it suddenly hits an immoveable object for example a golf club hitting the floor. A stress fracture can also occur and if it goes unnoticed it can progress and turn into a full fracture.

Treatment usually involves immobilization in a plaster cast for 4 weeks. If the injury is noticed late then it is likely not to heal in which case the most popular option is to remove the fragment of bone completely followed by immobilization in a cast for 3 weeks. Return to sports specific training may take 6 weeks or more. When the wrist comes out of the cast mobility and strengthening exercises should be done to restore full movement. Putty exercises and using hand exercise balls are excellent for achieving this.

If the X-ray reveals any complications, such as multiple fractures (comminuted) or displacement, then surgery may be required to realign the bones and hold them together whilst they heal.

Read more on hook of hamate fracture.

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