Wrist Fractures….
Wrist Fractures: Causes, Types, and Treatment Options
Understanding Wrist Fractures
A wrist fracture occurs when one or more of the bones in the wrist break due to trauma. The most commonly fractured bone in the wrist is the distal radius, which is the end portion of the radius bone near the wrist joint. Wrist fractures can occur due to falls, sports injuries, car accidents, or high-impact trauma. Individuals may also sustain wrist fractures from lower-energy mechanisms, particularly if they have underlying osteoporosis.
Associated Injuries and 'Distracting' Injuries
Patients with wrist fractures often experience associated injuries, which may not be immediately obvious due to pain and swelling around the wrist. These can include:
Ligament injuries within the wrist, leading to instability.
Scaphoid fractures, which are sometimes missed on initial X-rays.
Elbow or shoulder injuries, which may be overshadowed by wrist pain.
Soft tissue injuries, including nerve damage, such as median nerve compression, leading to symptoms like tingling or numbness in the fingers.
Types of Wrist Fractures
Wrist fractures can be classified based on their severity and involvement of the joint surface:
Non-displaced fractures: The bone remains aligned and may heal well with immobilisation.
Displaced fractures: The broken ends of the bone have shifted and may require realignment.
Intra-articular fractures: These fractures extend into the wrist joint, potentially affecting long-term function and increasing the risk of arthritis.
Comminuted fractures: The bone is broken into multiple pieces, often requiring surgical intervention.
Open fractures: The broken bone pierces the skin, increasing the risk of infection and requiring urgent surgical treatment.
Treatment Options for Wrist Fractures
The management of wrist fractures depends on their severity, displacement, and involvement of the joint.
Non-Surgical Treatment
Casting or splinting: Suitable for non-displaced fractures or minimally displaced fractures that can be realigned without surgery.
Pros: Avoids surgical risks, less costly, and generally effective for simple fractures.
Cons: Requires strict immobilisation for 4-6 weeks, may lead to stiffness, and may not be suitable for more complex fractures.
Surgical Treatment
For displaced or intra-articular fractures, surgery may be required to restore alignment and ensure proper healing.
K-wire Fixation (Pins/Wires)
Metal wires are inserted through the skin to hold the bones in place.
Pros: Minimally invasive, shorter surgery time.
Cons: Requires external support (cast), wires may need removal, higher risk of infection.
Plate and Screw Fixation
A metal plate is fixed to the bone with screws to stabilise the fracture.
Pros: Provides strong fixation, allows early movement.
Cons: More invasive, potential for metal irritation, and possible future surgery for hardware removal.
External Fixation
Used in severe cases or when soft tissue damage prevents internal fixation.
Pros: Allows stabilisation without disturbing soft tissues.
Cons: Bulky, risk of pin-site infection, longer healing time.
Long-Term Considerations
Some patients may require metal removal if plates or screws cause irritation or discomfort.
Intra-articular fractures that are not well-aligned can increase the risk of post-traumatic arthritis.
Accurate reduction and internal fixation can significantly decrease the likelihood of arthritis and improve long-term wrist function.
Physiotherapy is often needed after treatment to restore strength and motion.
Conclusion
Wrist fractures vary in complexity, and treatment should be tailored to the patient’s specific injury. While some fractures heal well with casting, others may require surgical fixation for optimal recovery. Early and accurate management can significantly impact long-term outcomes, reducing the risk of complications such as arthritis and stiffness. If you have sustained a wrist fracture, seeking prompt orthopaedic evaluation ensures the best possible recovery and function of your wrist.