Surgeons have utilized pins, pins with plaster, and external fixators.
Historically, there have been many methods to address wrist fractures. The patient is followed carefully in the office with x-rays at regular intervals to check that the fracture has maintained alignment and is healing Surgery Manipulation or Setting a Fractureįractures with displacement without communitarian may be candidates for manipulation or “setting the fracture.” These manipulations can be performed with local, regional or general anesthesia and the patient is typically placed into a splint or cast. Other criteria for adequate alignment also exist, but are not as correlated with overall results as angulation and intraarticular displacement. Fractures which have greater than two millimeters of intraarticular displacement are also candidates for improved alignment. Most Smith fractures are unstable and will require operative alignment. Fractures which show significant angulation of the distal radius for Colles fractures with over 10 degrees of dorsal tilt are candidates to improve alignment. Operativeįractures which have significant displacement of fracture fragments typically require realignment. Therapy for wrist and hand is common after these injuries even without surgical treatment and may require the utilization of a hand therapist. The length of immobilization may vary and after immobilization work is aimed at restoring wrist motion. Treatment Nonoperativeįractures without significant displacement may be treated with splints, casts or braces. In types 2-4 more displacement of the intraarticular fragments are shown. However, in type 1 the fracture shows no displacement. In both type 2 and 3 there is displacement of the fracture fragments. In Type 1 factures above the fracture fragments are well aligned or nondisplaced. Fractures which extend into the articular surfaces are more prone to have difficulty with range of motion and arthritis after healing. X-rays will also determine if the fracture is displaced. X-rays will also determine if the fracture is comminuted (many pieces) or if the fracture extends into the articular surfaces of the wrist or ulna. A fracture extending in the opposite direction is called a Smith fracture-only about 10% of wrist fractures are Smith Fractures. When the fracture displaces upward or outward it is termed a Colles fracture. The most common displacement of the fracture is upward as seen in the image above and below. X-ray will confirm the direction of the injury. At times, enhanced imaging including CT scans or MRI is a helpful adjuvant. Typically routine x-rays are sufficient, although they may be taken from many angles.
X-rays help delineate the type of fracture, displacement and if the fracture extends within a joint. X-rays of the wrist are obtained and if there is suspicion of injury to the hand, elbow or shoulder these may be obtained as well. Any deformity of the hand or wrist is also noted. Swelling from the fracture may cause compression of vascular structures leading to changes in blood supply to the hand. The most common nerve injured is the median nerve, resulting in numbness in the radial three digits of the hand. Sometimes patients with wrist fractures may have injured the nerves associated with the hand. Although unlikely, injuries to the adjacent shoulder and elbow are determined via checking for pain and motion.Īn examination of the sensation to the hand is performed. A physical exam centers on the injured limb. Inhibition of finger and wrist motion are also common.Ī fall causing a fracture of the distal radius-wrist fracture Hand Surgeon ExaminationĪfter taking note of the symptoms, the surgeon inquiries regarding any pertinent family or medical history. Patients tyically report pain, swelling, deformity, and bruising of the wrist. Image of a left wrist palm down showing the articulation of the radius with both the 8 wrist bones and the ulna Diagnosis SymptomsĪlmost all distal radius fractures occur as a course of trauma-the vast majority are due to falls on an ourstretched arm. Second, it articulates with the unlna to allow the hand to be turned palm up and palm down (pronation and supination). First, it articulates with the wrist to allow the wrist to bend and extend. The forearm is composed of the ulna and radius. The forearm connects the elbow to the wrist, allowing the hand to be placed into a functional position. The radius is the third most common bone to be broken in the human body. Patients who fall often fracture the radius. The forearm is composed of two bones, the radius and the ulna. A Patient’s Guide to Distal Radius Fractures (Broken Wrist) with Animated Surgical Video Introduction
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