What is Broken Wrist?
The wrist consists of ten bones which include the two forearm bones i.e. radius and ulna and eight small carpal bones which are known as Scaphoid, Pisiform, Trapezium, Lunate, Trapezoid, Capitate, Triquetrum, and Hamate. Carpal bones of the wrist and hand bones all together form the structure of the wrist.
A broken wrist is a condition related to break, crack or a fracture of any of bones of the wrist, that is distal end of one of the bones of the forearm namely ulna and radius or either of the carpal bones present in the wrist. The terms fractured bone and a broken bone are used for a similar condition and therefore have the advantage of interchanging of terms.
Generally, a broken wrist is often caused by falling down on an outstretched hand in order to break a fall. This usually puts stress or compression on a wrist bone resulting in condition of a broken wrist.
Broken wrist is a very frequent sports injury, especially in contact sports or ball games, which may include soccer, hockey, wrestling, basketball, American football, and rugby, however, broken wrist may also result from falls in adventure sports such as skateboarding, freestyle skiing, and snowboarding. Apart from this, individuals suffering from osteoporosis also tend to suffer easily with broken wrist because of their thin and fragile bones.
Broken wrist as such is just a generic or common term used to describe any fracture of the wrist bones, but broken wrist can be described in many other specific ways based on the type of fracture suffered. Given below are few examples:
Types of Broken Wrist
Wrist fractures are broadly classified into two types:
- Fractures of the ulna or radius.
- Fractures of the carpal bones.
Fractures of the Ulna and Radius:
Following are few of the fractures of the radius and ulnar bones.
Colle's Fracture: Colles fracture of the wrist is a condition described as a break in either of the bones of the forearm called as radius. The Colles fracture is a specific type of wrist fracture where there is displacement of the bone such that the wrist joint dislocates behind its normal anatomic position. The Colles fracture bends the wrist in an upward position.
Smith's Fracture: Smith fracture is also called as the reverse Colles fracture. A Smith fracture or a reverse Colles fracture is a condition which is caused when there is a rupture in the end of the radial bone located near the wrist. Smith's fracture bends the wrist in a downward position.
Chauffeur's Fracture: Chauffeur's fracture is a condition where the styloid process or the rounded portion of the radius is damaged.
Galeazzi's Fracture: Galeazzi's fracture is a condition which relates to fracture of the radius along with dislocation of the ulna.
Monteggia's Fracture: Monteggia's fracture is a condition which relates to fracture of the ulna along with dislocation of the radius.
Fractures of the Carpal Bones:
Following are few of the fractures of the carpal bones.
Scaphoid Fracture: Stress or compression could be placed on the scaphoid bone while performing certain activities like falling down on an outstretched hand. If the force is traumatic and beyond the tolerance power of the bone then this may result in breaking of the scaphoid bone resulting in scaphoid fracture.
Lunate Fracture: A lunate fracture is a condition relating to breaking or fracture of the lunate bone resulting from the high impact forces.
Triquetral Fracture: Triquetral fracture occurs when there is a break in the triquetrum bone due to high traumatic forces.
Causes of Broken Wrist
Most frequently, broken wrist may occur due to a particular incident like falling down on an outstretched hand. This could happen with any fall but is more frequent in sports. Apart from this, there are many more causes for broken wrist.
- Direct blow to the wrist.
- Falls while skateboarding or snowboarding especially in icy environments.
- Falls suffered by baseball players, divers, basketball players and gymnasts.
- Falls suffered by skaters.
- Falls while cycling.
- Weightlifting or boxing may also cause a broken wrist.
- Crushing injuries.
- Car accidents.
- Individuals suffering with osteoporosis often break their wrist easily.
- Calcium deficiency.
- Bone disease.
- Sports such as Football, Basketball, In-line skating, Wrestling, Skiing, Rugby and Hockey could also lead to breaking a wrist.
Signs and Symptoms of Broken Wrist
- Sudden pain immediately after injury or forceful impact on the wrist.
- Exacerbation of pain could also be experienced while attempting movements of the hand or the wrist.
- Development of swelling.
- Feeling of tenderness.
- Development of bruising.
- Wrist deformity such as a bent or misaligned wrist.
- Piercing of bone through the skin as in open fracture.
- Numbness and tingling in the hand or fingers indicative of nerve damage.
- Exacerbation of the pain while performing activities like gripping and squeezing.
- Stiffness is often experienced while performing movements of the thumb and fingers.
Treatment for Broken Wrist
It is very important that a broken wrist is treated as soon as possible. Delay in treatment may lead to misalignment of the bone or joint affecting the normal functioning of the wrist and hand. Early treatment also helps in addressing the problems of pain and stiffness in the early stages minimizing the possibility of any future issues.
Nonsurgical Treatment For Broken Wrist
Mild cases of broken wrist include just a displacement or deviation of the bone from its normal alignment. This may impair the use of the arm or wrist. Such deformities may be corrected with manipulation and reduction. Conservative care involves closed reduction with or without local anesthesia followed by casting or splinting of the wrist and hand. Fracture may require about six to ten weeks for complete recovery, which involves a period of immobilization for about four to six weeks followed by protective splinting for about six weeks.
Surgical Treatment For Broken Wrist
Surgery is required for more severe cases of broken wrist where the bone deformity is to an extent that it cannot be corrected with closed reduction. Typical example can be taken as multiple bone fragments at the fracture site, which may require placing the bones together and holding them until they unite and heal. Surgical method of correcting and realigning the bone to its normal position is known as open reduction.
Surgery involves making an incision and exposing the fracture to restore it to normal position. This may sometimes require use of hardware such as metal pins, plate, screws, or an external fixator device.
Surgery involves risks of infection, bleeding, neurovascular injury, as well as hardware failure.
Physical Therapy For Broken Wrist
Physical therapy is required for all the patients to speed up the healing process and restore normal functioning of the wrist and hand. Physical therapy may include:
- Joint mobilization.
- Soft tissue massage.
- Electrotherapy or ultrasound.
- Taping or bracing.
- Application of ice or heat.
- Exercises to improve strength and flexibility.
- Activity modification and training.
- Appropriate plan for return to activity.
Exercises for Broken Wrist
Stretching and strengthening exercises may need to be performed during the recovery phase to gain complete range of motion and functionality of the wrist.
Stretching Exercises for Wrist:
Flexion: This exercise is performed by smoothly bending the wrist forward until a pain-free stretch is felt. Hold this position for 5 seconds. Perform 2 sets of 15.
Extension: This exercise is performed by smoothly bending the wrist backward until a pain-free stretch is felt. Hold on this position for 5 seconds. Perform 2 sets of 15.
Side to Side: This exercise is performed by smoothly moving the wrist from side to side until a pain-free stretch is felt. Hold this position for 5 seconds in every individual direction. Perform 2 sets of 15.
Wrist Extension Stretch: This exercise is performed by keeping the elbow in a straight position and placing the fingers flat on a table with palms facing downwards direction. Next step is to lean the body weight forward and hold the position for about 15 seconds.
Wrist Flexion Stretch: This exercise is performed by keeping the elbow in a straight position and placing the hands on a table with palms facing upwards direction with fingers pointing towards the direction of the body. Next step is to lean away from the table and hold the position for about 15 to 30 seconds.
Forearm Pronation and Supination: This exercise is performed with the elbow at the side and bent to 90 degrees. Rotate the palm up and hold the position for 5 seconds. Gradually rotate the palm in downward position and again hold the position for 5 seconds. Perform 3 sets of 10 ensuring there is no exacerbation of symptoms.
Strengthening Exercises for Wrist:
Wrist Flexion: This exercise is performed by holding a hammer handle or soup can in the hand with palm facing the ceiling. Then bend the wrist in the upward direction. Gradually decrease the weight and come back to the starting posture. Perform 2 sets of 15. Slowly increase the weight of the object.
Wrist Extension: This exercise is performed by holding a hammer handle or soup can in the hand with palm facing downward. Slowly bend the wrist in the upward direction. Gradually decrease the weight coming back to the starting posture. Perform 2 sets of 15. Slowly increase the weight of the object.
Grip Strengthening: This exercise involves holding a tennis ball in the hand and squeezing it as hard as possible ensuring comfort without pain. Hold for 5 seconds and release. Repeat 5 to 10 times ensuring there is no exacerbation of symptoms.
Tests for Diagnosing Broken Wrist
A complete subjective and physical examination is necessary to diagnose a broken wrist. A thorough neurovascular examination of the hand and the digits is performed to assess for injuries to the nerves and vessels. Typically an x-ray is required for confirming the severity.
Other diagnostic tests may include:
- CT scan
- Bone scan.
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