Wrist Fractures
Breaks involving the end of the forearm bones or the small bones of the wrist, most often after a fall onto an outstretched hand.
A fall onto an outstretched hand is one of the most common ways to injure the upper limb, and the wrist is where the force tends to concentrate. The most frequently broken bone is the distal radius - the end of the larger forearm bone, just before the wrist.
The wrist is also made up of eight small carpal bones. One of these, the scaphoid, deserves particular mention: it has an unusual blood supply, its fractures can be difficult to see on early X-rays, and a missed scaphoid fracture can lead to long-term problems. Wrist pain after a fall that does not settle should be reassessed.
Treatment depends on the position of the bone, whether the joint surface is involved, how stable the fracture is, and the demands placed on that wrist.
Loading anatomy
Common symptoms
- Immediate pain and swelling after a fall onto the hand
- A visible deformity, sometimes described as a fork-like shape
- Pain with any wrist movement, and difficulty gripping
- Tenderness in the hollow at the base of the thumb, which can suggest a scaphoid injury
- Bruising that appears over the following days
- Numbness or tingling in the fingers, which should be reported promptly
Causes and contributing factors
- A fall onto an outstretched hand - by far the most common mechanism
- Sport, particularly contact sport, cycling and skiing
- Road traffic and higher-energy injuries, which tend to cause more complex fracture patterns
- Reduced bone density, in which a lower-energy fall can cause a fracture
How it is evaluated
The wrist is examined for deformity, for the specific points of tenderness that suggest which bone is injured, and for the function of nerves and circulation to the hand.
A distal radius fracture in an older adult is also an opportunity to consider bone health, since it can be the first sign of reduced bone density.
- Examination of alignment, swelling and specific tender points
- Assessment of nerve function and circulation, including symptoms of median nerve compression
- X-rays of the wrist, and dedicated scaphoid views where that bone is suspected
- CT scanning to define fractures involving the joint surface
- MRI in selected cases, particularly for a suspected scaphoid fracture not visible on X-ray
- Consideration of bone health assessment in appropriate patients
Clinical detail
Parameters assessed on imaging include radial height, radial inclination, volar tilt, articular step and gap, ulnar variance and involvement of the distal radioulnar joint.
Associated soft-tissue injury - scapholunate ligament disruption or triangular fibrocartilage complex injury - is not uncommon and may influence both management and the eventual outcome.
Acute median neuropathy in the setting of a distal radius fracture requires prompt assessment.
Nonsurgical treatment
Many wrist fractures are treated in a cast. If the bone has shifted, it may be realigned before casting - a closed reduction - usually with local anaesthetic.
The fracture is then monitored with repeat X-rays over the following weeks, because a fracture that starts in good position can still shift as the swelling settles.
- Closed reduction where alignment needs correcting
- A cast or splint, typically for several weeks
- Repeat X-rays to confirm the position is maintained
- Early finger, elbow and shoulder movement to prevent stiffness elsewhere in the limb
- Hand therapy once the cast is removed
Surgical treatment
Surgery is considered when the bone cannot be held in an acceptable position, when the joint surface is displaced, when the fracture is unstable or open, or when the demands on the wrist make accurate restoration important.
The aim is to restore the alignment of the bone and the joint surface, and to hold it securely enough to allow movement to begin.
- Plate and screw fixation
- Pins, sometimes combined with a cast
- External fixation in selected complex injuries
- Fixation of scaphoid fractures, which may be recommended for particular fracture patterns
- Bone graft in selected cases, particularly for fractures that have failed to unite
Recovery
Wrist fractures generally unite over six to twelve weeks, though this varies with the fracture and the individual. Movement, strength and confidence usually return over a longer period.
Stiffness in the fingers is a preventable problem, which is why finger movement is encouraged from the start even while the wrist itself is immobilised.
- Finger, elbow and shoulder movement from the outset
- Hand therapy for wrist motion and grip once healing allows
- Gradual return to driving, work and sport, guided individually
- Some aching with weather change or heavy use can persist
When to seek urgent care
Seek immediate medical attention - an emergency department - if you experience:
- An obvious deformity of the wrist after a fall
- A wound over the fracture, or bone visible through the skin
- Fingers that are pale, cold, blue or numb
- Numbness that is worsening, particularly in the thumb, index and middle fingers
- Pain that is severe, worsening and out of proportion to the injury
This list is not exhaustive. If something about your hand worries you, have it looked at.
Frequently asked questions
My X-ray was normal but my wrist still hurts. Should I do anything?
Yes - have it reassessed if the pain persists. Some wrist fractures, particularly of the scaphoid, are not visible on the first X-ray. Ongoing pain in the hollow at the base of the thumb after a fall is a well-recognised reason to repeat imaging.
Do I need surgery for a broken wrist?
Often not. The decision depends on the position of the bone, whether the joint surface is involved, how stable the fracture is, and what you need the wrist to do. Both casting and surgery are legitimate treatments for different fractures.
Will my wrist be as good as before?
Many people return to their previous activities. Some are left with a degree of stiffness or aching, particularly after fractures that involved the joint surface. What is realistic for your fracture is something your surgeon can discuss with you specifically.
Related conditions
Hand & Finger Fractures
Broken bones in the fingers or the metacarpals - the long bones of the palm - which may be treated with or without surgery depending on position and stability.
Carpal Tunnel Syndrome
Pressure on the median nerve where it passes through a narrow tunnel at the wrist, which can cause numbness, tingling and weakness in the hand.
Complex Hand Trauma
Severe injuries that damage more than one tissue system at once - bone, tendon, nerve, blood vessel and skin together.
Discuss wrist fractures with Dr. Champagne
A consultation begins with understanding your symptoms, how they affect what you do, and what has already been tried.