If you've broken a bone, the odds are one in 10 that it is in your wrist. But the fact that a broken wrist is a common injury doesn't mean it's one that's easily diagnosed or treated.
"There are several types of wrist fractures, and they’re definitely not all treated the same way,” says Carrie Swigart, MD, a hand surgeon and chief of Yale Medicine Hand and Upper Extremity Surgery. Dr. Swigart conducts research focused on developing innovative new approaches, including implants, to improve treatment of wrist fractures worldwide.
What is a wrist fracture?
The wrist joint connects the hand to the forearm. A wrist fracture can mean that a person has broken one of the small (carpal) bones in this joint or, more commonly, the distal radius, which is the larger of the two bones that make up the forearm. This bone most often breaks at the lower end, near where it connects to the bones of the hand and thumb.
How does a wrist fracture happen?
Virtually anyone can take a tumble and end up with a broken wrist, says Dr. Swigart, but the majority of the people she sees with the problem fall into one of two categories.
The first group is elderly men and women who are vulnerable to wrist fracture because of low bone density. Because their bones are fragile, “It doesn’t take much of a fall to break the wrist,” Dr. Swigart says.
Patients in the second group, she says, tend to be younger and more active, with fractured wrists resulting from what Dr. Swigart calls “higher energy mechanisms,” such as a skiing mishap or getting hit while playing contact sports. The breaks those patients sustain tend to involve the wrist joint and are often more severe, Dr. Swigart says.
How is a wrist fracture diagnosed?
A wrist fracture hurts, sometimes a lot. Symptoms include pain, tenderness, swelling and/or bruising. A doctor may diagnose a wrist fracture based on information gathered from the patient, a physical exam, and X-rays.
High-energy fractures are usually evaluated with a computerized tomography (CT) scan, in addition to X-rays, to better identify the pattern of the injury, says Dr. Swigart. Magnetic resonance imaging (MRI) is occasionally necessary, too.
How is a wrist fracture treated?
“Our treatment decisions are not only based on what the X-ray looks like but on who the fracture happened to, who that person is,” explains Dr. Swigart. Factors taken into consideration include whether one or more bones are broken, in one or several places; whether torn ligaments are involved, and whether there are other injuries that require treatment. The good news is, most people with wrist fracture recover fully. According to Dr. Swigart, the range of treatment options for wrist fracture include:
- Wearing a cast or splint, usually for five to six weeks, followed by physical therapy to gain strength and restore range of motion.
- Surgery to fix the break, using pins to hold the bone in place. The pins are usually temporary. After the outpatient surgery, patients wear a cast or splint for several weeks, and then have physical therapy.
- Reconstructive surgery, also an outpatient procedure, uses plates and screws to repair the damaged bone. Patients are required to wear a cast for two to three weeks, and then transition to a removable brace and begin physical therapy.
What makes Yale Medicine's approach to treating wrist fracture unique?
Treatment of wrist fracture can be quite complex. Dr. Swigart believes that patients benefit when treated by an orthopedic surgeon who specializes in hand surgery and performs many wrist fracture repair procedures.
“There are a variety of ways to fix a distal radius fracture, including several different types of implants,” explains Dr. Swigart. And while some types of implants are used often, others are only employed rarely. “It’s important to work with a doctor who knows about and is able to use all of them,” she adds.
Also of value, Dr. Swigart says, is Yale Medicine’s involvement in clinical research, which often gives patients access to leading edge techniques and therapies well before they become widely available. For example, she says: “My work includes both clinical and biomechanical research on treating wrist fracture, and our department has been consistently involved. Being involved in the research brings insights into why things work and which things work best.”