What is Closed Fracture of the Wrist?
A fracture is a break of a part of a bone anywhere in the body due to excessive stress being put on the bone. A fracture can also occur due to a high impact injury resulting in the bone to break. The sheer impact of force weakens the bone to the extent that it breaks. There are basically two types of fracture one is a closed fracture [1]and the other is an open fracture.
A Closed Fracture of the Wrist occurs when the bones of the wrist, although broken does not pierce through the skin and get exposed to the environment. An individual with a Closed Fracture of the Wrist will have immediate swelling and pain with difficulty moving the wrist, but will not have any signs of an open wound whereas in open fractures the broken bone penetrates through the skin and gushes out and is visible which requires immediate treatment for fear of infection and other debris contaminating the injured area.
A closed fracture of the wrist does not necessarily require surgical treatment and the bone is allowed to heal with just immobilization of the closed fracture of the wrist by way of a splint or a cast. In some cases of closed fracture of the wrist, surgery may be needed but it is never an emergency like in the case for open fractures, and the surgical procedure can be performed a few days after the injury if required. Surgery is required for closed fracture of the wrist only when there is significant damage done to the soft tissues around the wrist area, which may require repair due to closed fracture of the wrist.
What are the Causes of Closed Fracture of the Wrist?
Some of the causes of a closed fracture of the wrist are:
- Unexpected slip and falls on the wrist with the wrist getting hyperextended or hyperflexed.
- Direct blow to the wrist like from a gunshot wound.
- High impact automobile accidents where the airbags may not deploy causing the wrist to get fractured.
- Sporting injuries, especially while playing contact sports like football or rugby and falling directly on the wrist.
What are the Risk Factors[2] for a Closed Fracture of the Wrist?
Fracture can occur in any individual, but the bone health of an individual also determines the susceptibility of that individual for fractures. If the overall bone health of an individual is not good, then the chances of that individual incurring a fracture even with a small event are more. This is more common in the elderly population or people with bone disorders. Some of the medical conditions that may predispose an individual to closed fracture of the wrist are:
- Osteoporosis. [3]
- Advanced age.
- Disorders of the endocrine and gastrointestinal systems.
- Prolonged use of steroids.
- Prolonged inactivity, which may be due to any illness or during the time recuperating from any other injury.
- Smoking and alcohol use also make the bones weak.
What are the Symptoms of Closed Fracture of the Wrist?
The classic presenting feature of a Closed Fracture of the Wrist is intense pain and immediate swelling around the wrist. The pain becomes worse with even light palpation of the wrist. The individual will not be able to move the wrist to any significant degree. Some of the other symptoms of a closed fracture of the wrist are:
- A clear snapping sound at the time of the injury.
- Swelling, erythema, and bruising around the wrist.
- Visible deformity around the wrist.
How is Closed Fracture of the Wrist Diagnosed?
A closed fracture of the wrist can be diagnosed by just a routine physical examination and the symptoms that the patient is experiencing. Immediately after the injury when the individual presents to the emergency room, the treating physician will begin by taking a history as to how the injury occurred and try to gauge the impact of the injury.
An inspection of the wrist will then be carried out to look for any signs of visible deformity, erythema, or swelling. The wrist may be taken through range of motion to see whether the patient can move the wrist and if so to what extent and whether there is any pain when doing it.
Once a closed fracture of the wrist is suspected, then radiological studies will be done in the form of an x-ray which will clearly show a break in bone. In case if a closed fracture of the wrist is not visible on x-ray then more advanced studies in the form of a CT scan or an MRI may be performed to pinpoint the area of the broken bone and confirm the diagnosis of closed fracture of the wrist.
How is Closed Fracture of the Wrist Treated?[4]
Treatment of a closed fracture of the wrist is aimed at putting the bone back into its normal place, align it correctly, and allowing it to heal. It is extremely vital in treatment of closed fracture of the wrist that the wrist be immobilized to allow the fracture to heal and avoid any displacement of the bone from its normal position, which may complicate the situation further. During the healing phase of closed wrist fracture, new bone is formed around the edges of the broken pieces and connects them. The patient may be immobilized through a cast, splint, or brace till the time the closed fracture of the wrist is fully healed. During the healing phase, the patient will be given pain medications to control pain after a Closed Fracture of the Wrist.
What is the Recovery Time for Closed Fracture of the Wrist?
The recovery time for a Closed Fracture of the Wrist depends on the severity of the fracture. Normally, it takes four to six weeks for a closed fracture of the wrist to heal, but in some cases the healing may be delayed and it may take even a few months for the patient to completely recover from closed fracture of the wrist. Presence of other underlying medical condition also affects the healing rate of a closed fracture of the wrist. If the patient is a smoker and does not stop smoking after the fracture, then that individual may have a prolonged recovery time post a closed fracture of the wrist.
It should also be noted that once a fracture has healed due to prolonged immobilization, the muscles become stiff and hence physical therapy is necessary for the wrist to get back its range of motion and function allowing the individual to return to activities post closed fracture of the wrist. The physical therapy may begin with strengthening exercises followed by range of motion exercises and once the patient is able to do all the exercises pain free, then he or she is gradually allowed to go back to normal activities after sustaining a closed fracture of the wrist.
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