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Wrist Fracture

  • Site of extremity X-ray
  • Extremity X-ray

Definition

A wrist fracture is a break in one of the bones of the wrist. The wrist joint lies where the two bones of the forearm join the small bones of the hand. The wrist joint normally bends forward and extends backward. A significant amount of force in any one of these directions can cause one or more of these bones to break.

Risks

What are the causes and risks of the injury?

A bone fracture occurs when the force against a bone is greater than the strength of the bone. Common causes of wrist fractures include:
  • direct blow to the wrist, such as a sports injury
  • falling onto an outstretched hand
  • an injury that causes the wrist to bend sharply backward
Factors that increase a person's risk of bone fracture include:
  • cancers affecting the bone
  • diet low in calcium or vitamin D
  • eating disorders such as anorexia and bulimia
  • excess alcohol intake
  • family history of osteoporosis
  • medicines such as corticosteroids, certain medicines for seizures, and some medicines used for high blood pressure
  • hyperparathyroidism, a condition in which the parathyroid gland makes too much parathyroid hormone
  • hyperthyroidism, a condition in which the thyroid gland makes too much thyroid hormone
  • hypogonadism, a condition in which the ovaries in women or testes in men do not function normally
  • menopause or surgical removal of the ovaries
  • normal aging, which causes the bones to become more brittle
  • osteoporosis, excess bone thinning that results from loss of calcium in the bone
  • physical abuse, including child abuse, elder abuse, and spousal abuse
  • rheumatoid arthritis, a condition in which the body attacks its own joint tissue
  • sedentary lifestyle
  • smoking

Prevention

What can be done to prevent the injury?

Injuries that cause wrist fractures can sometimes be prevented by:
  • exercising caution when walking on ice or snow
  • following rules at pools, water parks, and other recreational areas
  • following sports safety guidelines for children, adolescents, and adults
To avoid wrist fractures in elderly individuals, the home should be made safe to prevent falls. Ways to increase safety include:
  • having comfortable shoes with nonslippery soles
  • having safe, well-lit, and uncluttered areas
  • using a cane or walker as needed
  • using no throw rugs on floors
  • using nonskid mats in the shower and bathtub
Intriguing new research done in older individuals with arthritis found that brisk walking or weight training improved balance in those individuals. Improved balance could very well help avoid wrist fractures from falls.
Bone loss, which increases a person's risk of fractures, can be slowed by doing 30 minutes of moderate weight-bearing exercise a day. Weight-bearing exercise includes low-impact aerobics, walking, running, lifting weights, tennis, and step aerobics. A person doing moderate exercise can talk normally without shortness of breath and is comfortable with the pace of the activity. The 30 minutes a day can be done all in one session or broken up into smaller time periods.
Individuals can help prevent osteoporosis, and thus reduce their risk of bone fractures by:
  • avoiding smoking
  • eating a well-balanced diet, following the food guide pyramid
  • eating 25 grams of soy protein daily
  • for women who have reached menopause, using hormone replacement therapy
  • getting effective treatment for conditions such as rheumatoid arthritis and hyperthyroidism
  • limiting alcohol intake

Diagnosed

How is the injury recognized?

Diagnosis of a wrist fracture begins with a medical history and physical exam. A joint X-ray can confirm the diagnosis. Rarely, a bone scan or MRI may be needed to detect hidden fractures.

Treatments

What are the treatments for the injury?

Treatments to reduce pain and swelling are initially used for a wrist fracture. This includes medicine, elevating the injured arm, and applying ice. The treatment then involves returning the bones to their proper position and realigning broken ends. A cast, which holds the repaired bones in place, is the most common treatment method. Sometimes a temporary splint is used to allow for swelling before a cast is put on.
Surgery may be necessary for a severe fracture. It may also be used if the bones are not realigned properly or if the skin is open. In rare cases, a bone graft is used. In this procedure, a piece of bone is used to replace a damaged bone. Joint X-rays will need to be taken frequently to make sure the fracture is in a good position throughout the healing process. Exercises to maintain the flexibility of the fingers, elbow, and shoulder are also recommended.

Side Effects

What are the side effects of the treatments?

Surgery can be complicated by infection, bleeding, or reactions to the anesthesia.

After Treatment

What happens after treatment for the injury?

Most wrist fractures heal without problems. Initially after the cast or splint is removed, the arm or wrist is pale and slightly weak from lack of use. Physical therapy may be necessary to restore normal motion, strength, and function. Over time and with careful use, strength is gradually regained.
Possible long-term effects may include:
  • arthritis
  • deformity, such as the shortening of one of the bones in the forearm
  • discomfort or stiffness
  • numbness or tingling in the hand
  • a weak grip
More serious long-term effects from a broken wrist can occur but are seen less often. Occasionally, tendons can be caught in scar tissue or break over a rough bone. Rarely, a person will develop "shoulder-hand syndrome," which includes:
  • bluish swelling of the hand and fingers
  • depression
  • pain
  • stiffness from the shoulder to the fingers
  • weakness
Any new or worsening symptoms should be reported to the healthcare professional.

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