The wrist is the joint formed by the 2 bones of the forearm (radius and cubite) and the first bones of the hand. Most wrist fractures are radius fractures near the wrist joint and are the result of falls that we rest on with the hand. These fractures result from minor falls in older people with weaker bones (osteoporosis). They also occur in younger people following falls from heights, sports or car accidents.
Radius fracture should be treated as soon as possible to relieve pain and to correct the position, alignment and relationship of the various constituent bones of the wrist joint, thus allowing proper healing and recovery of movement and function.
Radius fracture manifests with:
– severe pain that aggravates with joint movement
– edema (swelling)
– wrist deformity
– pain touching the affected area
Some clinical situations condition susceptibility to fractures:
- Osteoporosis or other bone disease
- Tobacco, this interferes with calcium absorption.
- Restrictive diets with low calcium or vitamin D intake
Sports: Contact, snow or jumping sports are at high risk of wrist trauma and consequent fractures.
Complications of radius fractures are directly related to fracture characteristics, treatment and rehabilitation.
- Wrist mobility limitation: Wrist pain and movement restriction usually decrease markedly about 2 months after removal of the cast or surgery, and up to 2 years of improvement. If the fracture is too complex or the patient does not follow the rehabilitation exercises proposed, movement limitation and pain may persist.
- Arthrosis: Fractures that extend into the joint condition an early aging of the joint and may develop into arthrosis after a few years.
- Nerve Compression: Some fractures by slightly altering the radius anatomy can cause the nerve, which is responsible for the innervation of half of the hand, to tighten along its wrist path, producing pain and numbness in half of the hand. This should be evaluated in consultation.
The diagnosis of a wrist fracture is made through medical and rx evaluation. Clinically, the presence of pain on palpation of the radius area, deformity and edema suggest the presence of fracture that is confirmed by the rx study. Computed tomography (CT) is rarely performed for the diagnosis of a wrist fracture but may be useful for studying the characteristics of complex fractures in order to plan surgical treatment. Magnetic resonance imaging is useful for studying non-bone lesions that may be associated with radius fractures but are usually not performed soon after the fracture but in the event of complaints that cannot be justified by the fracture.
The treatment of a radius fracture depends on its characteristics and alignment. If the radius fracture is properly aligned, the treatment involves placing a plaster splint that will be replaced after a few days by a plastered glove that will be kept for 4 to 6 weeks. During this period alignment can and should be confirmed with rx study. If necessary, plaster adjustments should be made to maintain fracture alignment. After removal of the cast a mobilization exercise protocol is started and if necessary the patient is sent to physiotherapy.
If the fracture is not aligned, reduction may be made to try to obtain proper alignment in the emergency room after placement of local anesthesia for pain relief. After the reduction maneuver a plaster splint is placed and a new rx is made. If misalignment has been corrected, the protocol described for aligned fractures follows. If the desired alignment has not been achieved, a further reduction maneuver may be performed or if the fracture characteristics are unable to maintain the desired position, surgical treatment may be chosen. Surgical treatment is not urgent and may be delayed a few days.
In surgery, the fracture is reduced so that the bone is as close as possible to the shape it was before the fracture, and the fracture stabilized with plates and screws. The goal is to achieve a stable construction that allows the removal of the plaster and the beginning of rehabilitation exercises. Some fracture patterns benefit from additional techniques such as arthroscopy or require special fixation systems such as external fixators.