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A wrist fracture is a break in one or more of the bones in the wrist.

Wrist Fracture
What is a Wrist Fracture?

A wrist fracture is a break in one or more of the bones in the wrist. The wrist is made up of the two bones in the forearm called the radius and the ulna. It also includes eight carpal bones. The carpal bones lie between the end of the forearm bones and the bases of the fingers. The most commonly fractured bone around the wrist is the lower end of the Radius. The fracture may be a simple fracture of the lower radius or could also have extensions into the wrist joint or the distal radio ulnar joint (Intra articular fracture). Treatment would depend on the type of the fracture.

Causes

The common causative injury is fall on the out stretched hand with the load of the falling body on the wrist. Other mechanisms include direct hit or blow and twisting forces. Elderly people with frail body structure and weak bones are more prone to wrist fractures even with trivial falls. Even simple falls at home on slippery surfaces or wet outdoor areas due to rain, sleet, snow can lead to wrist fractures.

Symptoms

These include pain, swelling, bruising around the wrist. The fractured bones ends usually loose alignment of the normal bone and there is deformity around the wrist. Movements are painful and restricted.

Diagnosis

This is fairly easy for a trained orthopaedic surgeon. There is obvious swelling and deformity. X rays are done to assess the fracture pattern so that proper treatment could be planned. In cases of severely comminuted fractures a CT scan with 3 D reconstruction may be necessary to study the fracture pattern.

Treatment

The type of treatment recommended would depend on the fracture pattern and whether he fracture involves surrounding joints – wrist or radioulnar. The goal of treatment is to align the fracture fragments into as normal an alignment as possible and maintain the same for 6 to 8 weeks for the fracture to heal. This can be achieved by –

  • Plaster cast which may need the patient to be anaesthetized for the procedure.
  • Closed reduction and metal wire fixation through the skin and cast. The procedure can be done with the use of intra operative computerized radiology.
  • Surgery – Open reduction and internal fixation. Devices like screws, screw plate construct, metal wires may be used singularly of in combination to achieve optimum results.
  • Surgery – external device to maintain alignment with metal pin purchase in the bones.
  • Calcium, protein and vitamin supplementation is necessary with any modality of treatment.
  • The advantages of closed reduction include minimum possible procedure however disadvantages include prolonged rehabilitation due to stiffness resulting from prolonged plaster cast periods. The advantages of operative treatment include early mobilization resulting minimum morbidity and stiffness however disadvantages include surgical trauma and the possible complications of the same like infection, anaesthesia risk.
    Kindly discuss with your orthopaedic surgeon about the best treatment for your fracture.

    Physiotherapy and Rehabilitation

    Usually the elderly people need to undergo a period of rehabilitation lasting up to 4 weeks. The average time is 6 to 10 days with a period of intermittent supervised rehab programme.

    Complications

    Possible list includes complications listed in the fractures section. Shoulder Hand syndrome is a typical complication seen rarely in cases of injuries to upper limb – is charactrised by severe pain, swelling and stiffness experienced during physiotherapy after removal of plaster cast. Due to this the patient does less physiotherapy and pain, stiffness goes on increasing. Patients are encouraged to do exercises despite pain so that the circle of complications is broken. Pain medications and other supportive treatment are prescribed as deemed necessary by your doctor.


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