A fracture of the wrist is a fracture of the forearm in the area near the hand (distal).
The wrist is formed by the end pieces of the forearm bones: ulna and spoke. There are also 8 small bones that connect the forearm to the hand: scaphoid bone, lunar bone, triangular bone, pea bone, large polygonal bone, small polygonal bone, head bone and hook bone.
The 4 proximal bones (closest to the forearm) form a joint with ulna and spoke, the other 4 a joint with the hand bones, from the first to the fifth metacarpal bone.
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Type of fracture:
- A wrist or colles fracture can involve one or both forearm bones.
This type of injury causes the displacement of the bone fragment towards the back of the hand. - A Smith fracture is the opposite of a Colles fracture. The bone fragment of the wrist shifts towards the palm.
The classic way to break your wrist is a fall with arms outstretched to protect your head. The hand is forcibly bent backwards.
If the fracture affects the right hand in a right-handed person, the fracture is more severe and causes greater disability than an injury to the left hand.
A bone fragment can damage the nerves that run through the wrist: radial nerve, median nerve, and ulnar nerve. In addition, the arteries and veins of the hand can be injured.
Who are those affected?
It is a fracture that is very common, especially in older menopausal women.
In young people and children, it is rather rare and usually occurs as a result of a sports accident: skiing, cycling, motocross, football, etc.
Children can also suffer a greenwood fracture, which means that only part of the bone breaks, leaving the external membrane (periosteum) intact.
Osteoporosis is a disease that affects almost all menopausal women and is characterized by a lower calcium density in the bones, making them more prone to fractures.
What are the symptoms of a wrist fracture?
In the acute stage, symptoms such as swelling and severe pain appear, the wrist stings very strongly.
Often a simple bruise is confused with a fracture, since the patient “jumps up” even with a small passive movement of the hand.
In the post-acute stage, the symptoms are unbearable pain when moving, pressing and squeezing objects with the fist.
If blood vessels, nerves or ligaments have also been injured, more serious symptoms may occur, such as hemorrhage or paralysis.
How to get a diagnosis?
The diagnosis is made clinically, but requires confirmation by an X-ray, because if the patient feels severe pain and can not move the hand, bruising must be excluded. An X-ray could therefore also show that the bone is not injured.
What to do? How is it treated?
If the joint is unstable and the fracture is displaced, the orthopedist may recommend surgical intervention to allow healing and speed recovery.
In the case of an incomplete or only slightly displaced fracture, a plaster cast or orthosis is applied, which immobilizes the hand and wrist for over a month. Only rarely does the orthopedist recommend immobilization of the joint for 2 months.
In the first month after the accident, the patient must have an X-ray check every two weeks.
If the orthopedist believes that callus formation on the bone is sufficient, he can remove the plaster cast or orthosis.
Even after a surgical procedure, you have to wear a plaster cast.
Even if doctors do not specifically recommend it, it is important to carry out magnetic therapy over the first 30 days, which shortens the duration of consolidation by up to 50% and significantly relieves pain.
To relieve the pain, other instrumental therapies can also be used, such as laser or Tecar therapy®.
The swelling persists for a few weeks after the accident and can be reduced by using alternating baths at home by immersing the wrist first in cold and then in warm water.
It is important that there is a temperature difference of about 10°.
Exercises for rehabilitation and physiotherapy
If the X-ray shows calcification of the fracture, one should start physiokinesitherapy; this is especially important for the wrist and hand, as the movements are very fine and precise.
When the plaster cast is removed in older women, they often feel severe pain for the first week, especially if magnetic therapy has not been carried out for at least 1 hour per day.
The muscles of the forearm and hand become weaker and must therefore be strengthened first with isometric exercises (tensing without movement) and then by lifting objects or weights.
The restoration of mobility is achieved through exercises that involve the fingers, wrist and forearm. In particular, the focus is on:
- pressing the thumb and the other fingers together (opposing of the thumb);
- inward rotation of the forearm (pour water out of a bottle);
- Outward rotation of the elbow (turning a door handle).
How long does it take to recover before I can return to work or play?
The recovery time for a simple fracture is short and usually the patient can return to his normal daily activities after only two months without severe pain.
With a displaced fracture of the wrist (and possibly a multiple fracture), the prognosis in elderly people with osteoporosis exceeds 3 months and can also last up to 6 months without treatment.
For young people, the time is shortened considerably, but it takes at least 3 months to return to work or sports.
Possible consequences and after-effects of a wrist fracture:
- Poor merging (not correctly aligned), which can cause functional limitations in the event of a displaced fracture.
- Post-traumatic osteoporosis of the wrist and hand, in the form of Sudeck’s disease.
