Fractures of the wrist are one of the most common injuries treated by orthopedic surgeons. We typically see wrist fractures in one of two settings and in a bimodal age distribution. Younger patients with normal bone density, typically sustain high energy injuries such as a fall off a ladder, whereas an older individual can sustain a fracture from a low energy injury such as a fall while playing tennis or pickleball. The difference between the two is very important, as a low energy injury typically indicates that the bone was not strong enough to withstand the impact. This can indicate a more serious underlying bone deficiency such as osteoporosis. The lifetime risk of sustaining an osteoporotic fracture is 40% in women and 30% in men. Quite often an individual has never had a bone density test or was told they had a normal bone density at the time of presentation to an orthopedic surgeon with a fracture.
Below is a list of the most common questions I receive from my patients at the time of their initial evaluation for a wrist fracture.
I went to the ER and was told I have a wrist fracture. What bones are involved in a wrist fracture?
The radius carries approximately 80% of the axial load at the joint surface, and typically is the bone injured in a wrist fracture.
How quickly should I see an orthopedic upper extremity specialist after my injury?
You should ideally be evaluated by a specialist within one week of your injury. If by chance surgical intervention is indicated for your fracture, it does become more difficult as the time passes, and the bones begin to heal in a poor position.
What should I do while I wait for my specialist appointment?
The most important thing you can do is refrain from any lifting, pulling, or pushing activities. These activities will increase your discomfort and can allow the bones to shift into a position that may require future surgical intervention. In addition, if there was no injury to your fingers, elbow, or shoulder, you will want to move these joints to prevent stiffness. I always tell my patients that their goal should be to make a full fist and have full extension of their fingers within a few days of their injury.
I was told my wrist is “shattered”, does that mean I need surgery?
No, it does not. There are certain radiographic criteria that are utilized to help decide if surgical intervention will improve someone’s ultimate functional outcome. In addition to these criteria,
I also keep in mind the activity level of my patients in conjunction with their concurrent medical conditions. I always tell my patients that I don’t just treat an X-ray, I treat them as a whole individual and the X-ray is only one component of this decision tree. I enjoy reviewing the X-ray findings and helping my patients come to a decision regarding their treatment plan.
If I don’t have surgery, what are my other options?
Conservative treatment options for a wrist fracture include casting, splinting, or a combination of the two. I typically follow my patients weekly for three weeks following initiation of conservative treatment. This is to assure there is no change in alignment of the fracture. One can expect to be immobilized in a cast and/or splint for a total of six weeks prior to initiating wrist range of motion. Sometimes at the end of the immobilization period, individuals may be referred to an occupational therapy to improve their range of motion and further down the line to improve their grip strength.
What does surgery involve?
Surgical intervention involves making an incision to access the fracture fragment(s), in order to improve the alignment and restore stability to the wrist so early range of motion can be instituted. There are a variety of implants that can be utilized to achieve the desired outcome. Often these plates and screws are retained indefinitely, however, depending on the fracture pattern and bone quality, there is a possibility that certain types of plates must be removed once the bone is healed.
What should I expect after surgery?
The first office appointment will occur two weeks after the date of surgery, at which time the sutures are removed, and a removable splint is applied. There is an 8-10 week period post-operatively that you must refrain from any lifting, pulling, or pushing with the operative hand. At 12 weeks I typically allow my patients to return to all activities gradually with