Wrist fracture

Wrist fracture

This is a fracture of one or both of the forearm bones, the radius and ulna at wrist level. The mechanism is most often a fall with landing on the extension hand. The most frequent symptoms are pain, significant swelling, a deformity of the wrist commonly described as the “back of a fork”, and sometimes tingling in the thumb, index and middle fingers.

What tests are needed for wrist fractures?

X-rays are usually sufficient to confirm the diagnosis. They can be used to locate the fracture, the number of fragments and any displacement. Sometimes images don’t provide enough information. In this case, a scanner may be required for greater precision.

What are the treatments for this fracture?

• Non-surgical

In cases where the fracture is not or only slightly displaced, “conservative” treatment can be attempted. A plaster cast is applied for four to six weeks.

Sometimes the fracture is “simple”, but the fragments are displaced. In this case, a manoeuvre to realign the fragments can be performed under local anaesthetic. The aim is to allow the bone to return to its proper position, and then to consolidate while still held in a cast.

X-rays are taken at regular intervals to ensure that the bone remains in the correct position. If reduction manoeuvres are not effective, or if the fragments move despite immobilization, surgical treatment may be required.

• Surgical

In the case of complex fractures, e.g. where there are several fragments or the fracture is highly unstable, surgery is often necessary. The aim is to realign the fragments so that the bone can consolidate properly. There are various ways to maintain bone. In most cases, plates and screws are used. The scar is usually on the palm side of the wrist.

This type of procedure can be performed on an outpatient basis, although in complex cases a short hospital stay is preferable. This is a locoregional anesthesia (the entire limb is operated on). A cast is applied at the end of the operation, to be worn for between two and six weeks, depending on the fracture. On leaving the surgery center, with the arm still asleep, it is not possible to drive home.

Regardless of the technique used, a follow-up consultation takes place approximately one week after the operation. New X-rays are taken to ensure that the fracture is properly maintained. Sutures are removed about two weeks after surgery, unless they are absorbable.

Once the cast has been released, rehabilitation (physiotherapy or occupational therapy) is often required. Needs are assessed on a case-by-case basis by the surgeon.

It’s important to understand that it takes three months for the bone to become as solid as before (sometimes longer for smokers). It is therefore necessary to resume activities and efforts gradually and cautiously. The length of time off work depends on the profession, but usually ranges from two weeks to three months. Sports activities involving the risk of falling or the use of the operated wrist should be avoided for two to three months.

What are the possible complications?

Common to all surgeries

Infection of the wound may occur, but is usually cured by local care and the prescription of antibiotics. Surgical drainage is rare.

Hematoma corresponds to an accumulation of blood under the skin. It’s not a problem if it’s small, but if it’s larger, surgical evacuation may be necessary.

Healing problems (delayed healing, thick scars) occur more frequently in patients who smoke.

Inadvertent injury to an artery, nerve, ligament or tendon is always possible, although rare. These structures can be repaired, but recovery may be prolonged or even incomplete.

Chronic regional pain syndrome is a disproportionate inflammatory reaction of the body following surgery. It causes pain, swelling and stiffness, requiring treatment that can last several months.

Complications specific to wrist fracture

The fracture may move during the first few weeks of treatment, despite immobilization in a cast, whether or not surgery has been performed. Depending on the extent of the displacement, surgery may be required. When the fracture has shifted and consolidated in a bad position (callus), an operation may be proposed to break the bone again, replace it in a good position and hold it in place with a plate and screws.

On rare occasions, the fracture may not consolidate within the usual three-month period (delayed consolidation) or may not consolidate at all (pseudarthrosis). Once again, surgery can be proposed in these cases.

The risk of developing premature cartilage wear, i.e. osteoarthritis, can occur with certain fractures, particularly if they affect the joint.

Compartment syndrome is a condition in which the muscles of the forearm are compressed within their envelope. This takes the form of severe pain that is not relieved by painkillers. This syndrome tends to be associated with severe accidents (road accidents, falls from great heights). Treatment is surgical, since the muscle envelopes have to be opened.