Broken wrist: what are my treatment options?

A broken wrist is a fracture of one or more of the bones in the wrist, most commonly the distal radius. It typically results from a fall onto an outstretched hand and causes pain, swelling, and sometimes deformity. Treatment varies from casting to surgery, depending on fracture severity. Leading consultant trauma and orthopaedic surgeon Mr Angelos Assiotis provides a guide to the symptoms and surgical options for treating wrist fractures.

What are the symptoms of a broken wrist?

The wrist joint is a complex structure formed by several closely related bones. Most fractures in this area involve the distal radius, the largest bone in the wrist, which also connects to the forearm and elbow. Distal radius fractures are very common and typically occur from falling onto an outstretched hand. These fractures cause significant wrist pain and often result in a visible deformity compared to the uninjured side. Patients with such injuries often have difficulty moving their fingers because the tendons responsible for finger movement pass over the fracture site. Subsequent symptoms include substantial swelling, bruising, and a 'pins-and-needles' sensation in the fingertips.

What are the different types of distal radius fractures?

Fractures of the distal radius can be classified as either closed or open, based on whether there is an associated skin wound over the fracture. Open fractures require urgent treatment, typically surgery within the next day, while closed fractures can usually be treated a few days after the injury.

Another important categorisation is between two-part (simple) fractures and multi-fragmentary (more complex) fractures, which influences the treatment approach. To assess the complexity of a distal radius fracture, an X-ray is typically performed, and sometimes a CT scan is also needed to guide treatment decisions.

When is surgery necessary for treating a wrist fracture?

Not all fractures of the distal radius require surgery; many can be treated with a plaster cast or removable splint for several weeks. However, if the fracture involves the joint surface of the wrist or is significantly displaced or angled as seen on X-rays, surgery may be necessary. The goals of surgery are to restore the normal anatomy of the distal radius and stabilise the fracture, allowing the patient to move their wrist as soon as possible.

What are the different surgical options available for repairing a wrist fracture?

If surgery is indicated for a distal radius fracture, several options are available. One method involves stabilising the fracture with stainless steel pins, known as 'K-wires,' which hold the bone fragments in place during healing. These pins are supported by a plaster cast, and both the pins and the cast are typically removed after four weeks. Removing the pins is a simple procedure done in the clinic and does not require another operation.

For fractures that are significantly displaced or consist of more than two fragments, specially designed titanium alloy plates may be used. These plates are placed directly on the bone surface through a skin incision and are secured with screws that hold the bone fragments together during healing. These plates are intended to remain in the body and do not require routine removal.

What is the typical rehabilitation process after wrist fracture surgery?

For fractures treated with a plaster cast and no surgery, patients typically wear the cast for four to six weeks. After the cast is removed, physiotherapy begins. If surgery is performed using a plate and screws, a plaster cast is usually not needed, and patients can start moving their wrist immediately. Although movement is allowed, heavy lifting and contact sports are restricted for about three months following surgery. With physiotherapy, patients generally regain normal or near-normal range of motion and return to normal activities after several sessions of physiotherapy.

If you require wrist surgery and would like to book a consultation with Mr Assiotis, do not hesitate to do so by visiting his Top Doctors profile today.