Wrist Fractures

Wrist fractures represent one of the most common bone injuries encountered in medical practice, affecting a wide demographic from young athletes to the elderly. This type of fracture occurs when one or more bones in the wrist area, primarily the radius, ulna, or any of the eight small carpal bones, are broken.

Wrist fractures can range from simple breaks that require minimal treatment to complex fractures that necessitate surgical intervention.

Wrist fractures typically result from a direct impact on the wrist or compressing forces exerted on the wrist. The most common causes include:

• Falls
  Extending the hand to cushion a fall can transmit significant force to the wrist, potentially causing fractures. This is a common cause among all age groups, especially in icy conditions or during sports.
• Osteoporosis
  This condition weakens bones, making them more susceptible to fractures. A minor fall or even a sudden twist can lead to a wrist fracture in individuals with osteoporosis.
• Motor Vehicle Accidents
  The high-impact forces involved in car or motorcycle accidents can cause severe wrist injuries, including fractures.
• Sports Injuries
  Activities that involve a high risk of falling or collisions, such as skateboarding, skiing, or contact sports, can lead to wrist fractures.
• Direct Blows
  Any direct impact to the wrist, such as being struck by a ball or during a physical altercation, can cause a fracture.

The symptoms of a wrist fracture can vary depending on the severity and type of the fracture but typically include:

• Tenderness
  The injured area may be particularly sensitive to touch or pressure.
• Swelling
  Noticeable swelling around the wrist can extend to the hand or forearm.
• Limited Mobility
  Difficulty in moving the wrist, hand, or fingers, or an inability to carry objects or perform tasks requiring grip strength.
• Deformity
  In severe fractures, there may be an obvious deformity of the wrist, such as a noticeable bend or an unnatural wrist or hand position.
• Pain
  Immediate and potentially severe pain at the time of injury, which might worsen when moving the wrist or when pressure is applied.
• Bruising
  Discoloration and bruising around the affected area may develop soon after the injury.
• Numbness
  In some cases, there may be numbness or tingling in the fingers, indicating nerve involvement.

The process of diagnosing a wrist fracture involves a combination of clinical examination and imaging tests, enabling orthopaedic surgeons to assess the injury accurately and determine the most appropriate course of treatment. Key steps in the diagnostic process include:

• Medical History
  The orthopaedic surgeon will inquire about the circumstances of the injury, previous wrist injuries or surgeries, and any existing medical conditions that might affect the bones, such as osteoporosis.
• Physical Examination
  The wrist will be thoroughly examined to evaluate pain, swelling, tenderness, deformity, and range of motion. The orthopaedic surgeon may also assess sensation and blood flow to check for signs of nerve damage.
• X-rays
  The primary imaging test used to diagnose wrist fractures, X-rays can reveal the location, type, and extent of the fracture. They are effective in identifying breaks in the bone but may not always show minor fractures, such as those in the scaphoid bone, immediately after the injury.
• Computed Tomography (CT) Scan
  A CT scan may be ordered to provide more detailed images of the fracture, especially if the bones have moved out of place or if the injury involves the joints. This imaging modality is particularly useful for complex fractures.
• Magnetic Resonance Imaging (MRI)
  MRI scans can detect fractures not visible on X-rays, particularly in the carpal bones, including the scaphoid. They are also useful for assessing soft tissue injuries that may accompany the fracture.
• Bone Scan
  In cases where a fracture is suspected but not visible on X-rays, a bone scan might be recommended. This involves injecting a small amount of radioactive material into the bloodstream, which accumulates in areas of bone growth and highlights fractures.

Surgical intervention may be considered for wrist fractures that are displaced, involve the joint surface, or cannot be adequately stabilised with non-surgical methods. Common surgical procedures for wrist fractures include:

• Open Reduction and Internal Fixation (ORIF)
  This procedure involves realigning the fractured bone fragments and securing them in place using metal plates, screws, or pins. ORIF is commonly used for complex or unstable fractures to ensure accurate alignment and stabilisation.
• External Fixation
  In cases where internal fixation is not feasible or when temporary stabilisation is required, external fixation may be used. This involves placing screws or pins into the bone above and below the fracture site, which are then connected to a stabilising frame outside the skin.
• Bone Grafting
  A bone graft may be necessary for fractures that result in significant bone loss or do not heal properly (nonunion). This involves transplanting bone tissue from another part of the body or using a synthetic bone substitute to promote healing and provide structural support.
• Wrist Fusion (Arthrodesis)
  In severe cases where the wrist joint is extensively damaged and cannot be repaired, wrist fusion may be performed. This procedure involves removing the damaged joint surfaces and fusing the bones, eliminating joint motion to alleviate pain while providing a stable wrist.