Wrist Fracture – Open Reduction and Internal or External Fixation

The wrist comprises multiple joints, including the Midcarpal Joint and the Radiocarpal Joint, formed by several bones in the hand and two in the forearm. These joints allow for the positioning of the hand and fingers during movement.

The Radiocarpal Joint is formed by two forearm bones and three hand bones, interconnected by muscles and ligaments. This structure facilitates movements like gripping objects, such as bicycle handlebars or a steering wheel.

The two most commonly fractured bones are the Scaphoid and the Radius. The Radius, located on the thumb side of the forearm, is the widest bone in this area. The Scaphoid, a small bone on the thumb side of the wrist, is also prone to fractures.

Wrist fractures typically occur from a fall onto an outstretched hand. This action exposes the wrist to two major impacts: first, from the ground, and second, from the weight of the body. The specific type of wrist fracture that occurs is influenced by the wrist's position at the moment of impact.

Scaphoid fractures are most prevalent among men aged 20 to 40 and are often associated with falls, sports injuries, or motor vehicle accidents. These fractures usually happen when the wrist is bent at a 90-degree angle or more during a fall.

Colles fractures, a type of Radius fracture, are particularly common in older adults, especially women with osteoporosis. Children can also experience wrist fractures, known as Torus fractures, due to the flexibility of their bones.

Symptoms of a Scaphoid fracture can be mild and may vary by individual. Swelling may occur, but there may not be any visible deformity. Some people mistake the injury for a simple wrist sprain, but symptoms can include swelling, pain, or tenderness on the wrist's back near the thumb. Pain often intensifies during gripping activities and can manifest as a dull ache during rest. Tenderness may also be present in the Anatomical Snuffbox, a small depression at the thumb's base.

Colles fractures typically result in noticeable pain and swelling just above the wrist. Individuals may struggle to lift or carry lightweight objects, and the arm may appear deformed above the wrist due to the backward angle of the broken bone.

If you suspect a wrist fracture, seeking prompt medical attention is essential. Your doctor will evaluate your wrist and inquire about the injury's circumstances. X-rays are typically the first step in diagnosing fractures, providing clear images of the bones.

In certain cases, additional imaging tests, such as CT scans or MRI scans, may be ordered for a more detailed view of wrist structures. These procedures are painless, requiring the patient to remain still while images are taken.

Wrist fracture treatment varies based on individual circumstances, with the fracture's location and type determining the appropriate approach. Many fractures can be managed non-surgically.

Most Scaphoid fractures can be treated effectively with casting, though surgery is often recommended for better alignment. A cast helps stabilize the bones during the healing process and is typically worn for six weeks to six months. Colles fractures are usually treated with casting or splinting, generally lasting four to six weeks.

Surgical intervention may be necessary for fractures that do not heal properly or if the bones are misaligned. The type of surgery will depend on the fracture's location and nature, with options including Open Reduction and Internal Fixation or Open Reduction and External Fixation.

Open Reduction and Internal Fixation involves using surgical hardware to stabilize the fracture internally. The surgeon will make an incision, reposition the bones, and secure them with pins, screws, or metal plates.

Open Reduction and External Fixation stabilizes the fracture externally. After repositioning the bones, surgical pins are inserted through the skin to secure them to a metal frame outside the wrist.

After surgery or casting, physical or occupational therapy will aid in regaining wrist movement, strength, and function. Recovery time varies by individual, influenced by the fracture type and treatment received. Generally, wrist fractures heal over several weeks, with full recovery taking several months. Most patients experience favorable outcomes and regain substantial wrist function.