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Wrist Fractures

Distal Radius Fractures:

The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the area of the radius near the wrist breaks.

Distal radius fractures are very common. One of the most common distal radius fractures is a Colles fracture, in which the broken fragment of the radius tilts upward.

The most common cause of a distal radius fracture is a fall onto an outstretched arm.

A broken wrist can happen even in healthy bones, if the force of the trauma is severe enough. For example, a car accident or a fall off a bike may generate enough force to break a wrist.

Dr. Parikh and his team  will discuss with you all the treatment options for a distal radius fracture. The choice decided depends on many factors, such as the nature of the fracture, your age and activity level.

Treatment

Non-Surgical

If the broken bone is in a good position, a plaster cast may be applied until the bone heals.

If the position (alignment) of your bone is out of place and likely to limit the future use of your arm, it may be necessary to re-align the broken bone fragments. "Reduction" is the technical term for this process in which the doctor moves the broken pieces into place. When a bone is straightened without having to open the skin (incision), it is called a closed reduction.

After the bone is properly aligned, a splint or cast may be placed on your arm. A splint is usually used for the first few days to allow for a small amount of normal swelling. A cast is usually added a few days to a week or so later, after the swelling goes down. The cast may be changed in 2 or 3 weeks later if the swelling goes down more, causing the cast to loosen.

Depending on the nature of the fracture, Dr. Parikh and his team will closely monitor the healing by taking regular x-rays. . If the fracture was reduced or thought to be unstable, x-rays may be taken at weekly intervals for 3 weeks and then at 6 weeks. X-rays may be taken less often if the fracture was not reduced and thought to be stable.

The cast is removed about 6 weeks after the fracture happened. At that point, physical therapy is often started to help improve the motion and function of the injured wrist.

Surgical

Sometimes, the position of the bone is so much out of place that it cannot be corrected or kept corrected in a cast. This has the potential of interfering with the future functioning of your arm. In this case, surgery may be required.

Procedure. Surgery typically involves making an incision to directly access the broken bones to improve alignment (open reduction).

Depending on the fracture, Dr. parikh will use any number of options for holding the bone in the correct position while it heals:

  • Cast

  • Metal pins (usually stainless steel or titanium)

  • Plate and screws

  • External fixator (a stabilizing frame outside the body that holds the bones in the proper position so they can heal)
  • Any combination of these techniques

Open fractures:

Surgery is required as soon as possible (within 8 hours after injury) in all open fractures. The exposed soft tissue and bone must be thoroughly cleaned (debrided) and antibiotics may be given to prevent infection. Either external or internal fixation methods will be used to hold the bones in place. If the soft tissues around the fracture are badly damaged, Dr. Parikh will apply a temporary external fixator. Internal fixation with plates or screws may be utilized at a second procedure several days later.

Pain Management

Most fractures hurt moderately for a few days to a couple of weeks. Many patients find that rest the wrist, using ice, elevation (holding their arm up above their heart), and simple, non-prescription medications for pain relief are all that are needed to relieve pain.

Dr. Parikh may recommend combining ibuprofen and acetaminophen to relieve pain and inflammation. The combination of both medications is much more effective than either one alone. If pain is severe, patients may need to take a prescription-strength medication, often a narcotic, for a few days.

Cast and Wound Care

In some cases, original casts will be replaced because swelling has gone down so much that the cast becomes loose. The last cast is usually removed after about 6 weeks.

During healing, casts and splints must be kept dry. A plastic bag over the arm while showering should help. If the cast does become wet, it will not dry very easily. A hair dryer on the cool setting may be helpful.

Most surgical incisions must be kept clean and dry for 5 days. Dr. Parikh would like to see you back in the office 7 days after surgery to remove the sutures (stitches). If you do not have your first post-op visit scheduled, call our office to make one.

After surgery or casting, it is important that you achieve full motion of your fingers as soon as possible. If you are not able to fully move your fingers within 24 hours due to pain and/or swelling, contact Dr. Parikh office for evaluation.

Dr. Parik and his team  may loosen your cast or surgical dressing. In some cases, working with a physical or occupational therapist will be required to regain full motion.

Most people do return to all their former activities after a distal radius fracture. The nature of the injury, the kind of treatment received, and the body's response to the treatment all have an impact, so the answer is different for each individual.

Most patients will be able to resume light activities, such as swimming or exercising the lower body in the gym, within 1 to 2 months after the cast is removed or within 1 to 2 months after surgery. Vigorous activities, such as skiing or football, may be resumed between 3 and 6 months after the injury.

Hand Fracture:

Fractures of the hand can occur in either the small bones of the fingers (phalanges) or the long bones (metacarpals). They can result from a twisting injury, a fall, a crush injury, or direct contact in sports.

A physical examination is done to check the position of the fingers and the condition of the skin. Dr. Parikh and his team  will assess the fracture which may include some range of motion tests and an assessment of feeling in the fingers. This will ensure that there is no damage to the nerves. X-rays identify the location and extent of the fracture.

Treatment

Non-Surgical

Most of the time, the bones can be realigned by manipulating them without surgery. A cast, splint or fracture-brace is applied to immobilize the bones and hold them in place. The cast will probably extend from the fingertips down past the wrist almost to the elbow. This ensures that the bones remain fixed in place.

A second set of X-rays will probably be needed about a week later. These X-rays are used to ensure that the bones have remained in the proper position.

The cast will be worn for three to six weeks. Gentle hand exercises can probably be started after three weeks. Afterward, the finger may be slightly shorter, but this should not affect the ability to use the hand and fingers.

Surgical

Some hand fractures require surgery to stabilize and align the bones. These fractures usually break through the skin or result from a crushing accident. An orthopaedic surgeon, Dr. Parikh can implant wires, screws, or plates in the broken bone to hold the pieces of the fractured bone in place.

If the bone changes position while healing, the finger may lose some function.

One of the bones in the ring finger rotated abnormally during the healing process. When the finger is closed over the palm, the finger rotates but when the fingers are extended, the finger appears straight.

After the bone has healed, Dr. Parikh and his team will evaluate the healing and may remove the implants or may leave them in place.

Dr. Parikh and his team will want to examine the hand periodically to ensure that the joint doesn't tighten (contract) during healing.

Joint stiffness may be experienced because of the long immobilization period. Exercises can help restore strength and range of motion. A physical therapist may be able to help with this.

Scaphoid Fracture:

The scaphoid is one of the small bones in the wrist. It is the wrist bone that is most likely to break. The scaphoid is located on the thumb side of the wrist, in the area where the wrist bends.

Cause

A scaphoid fracture is usually caused by a fall on an outstretched hand, with the weight landing on the palm. The end of one of the forearm bones (the radius) may also break in this type of fall, depending on the position of the hand on landing.

Fractures of the scaphoid occur in people of all ages, including children. The injury often happens during sports activities or a motor vehicle accident. Men aged 20 to 30 years are most likely to experience this injury.

There are no specific risks or diseases that increase the chance of having a scaphoid fracture. Some studies have shown that use of wrist guards during activities like inline skating and snowboarding can decrease the chance of breaking a bone around the wrist.

X-rays can show if a bone is broken and whether there is displacement (a gap between broken bones). Sometimes, a broken scaphoid does not show up on an x-ray right away. If this is the case, Dr. Parikh and his team may put your wrist in a splint for a week or two. A new x-ray will be taken to see if the fracture  becomes  visible. The splint should be worn during this waiting period, and heavy lifting should be avoided.

A magnetic resonance image (MRI) scan may be taken to visualize the bones and soft tissues. This sometimes shows a fracture of the scaphoid before it can be seen on an x-ray.

Treatment

Non-Surgical

Fracture Near the Thumb

Scaphoid fractures that are closer to the thumb usually heal in a matter of weeks with proper protection. This part of the scaphoid bone has a good supply of blood, which is necessary for healing.

Dr. Parikh and his team will place your arm and hand in a cast. The cast will usually be below the elbow. It may or may not include the thumb.

The time it takes for the fracture to heal varies from person to person. Dr. Parikh and his team  will monitor the healing by taking periodic x-rays or other imaging studies, such as a computed tomography (CT) scan. These imaging studies are used to confirm that the bone has healed.

Fracture Near the Forearm

If the scaphoid is broken in the middle of the bone (waist) or closer to the forearm (proximal pole), healing is more difficult. These areas of the scaphoid do not have a very good blood supply.

Dr. Parikh and his team will  treats this type of fracture with a cast, the cast will probably include the thumb. It may extend above the elbow, as well.

Surgical

If your scaphoid is broken at the waist or proximal pole, Dr. Parikh and his team  may recommend surgery. During surgery, metal implant such as screws and wires”are used to hold the scaphoid in place until the bone is fully healed.

The incision may be on the front or the back of the wrist depending on what part of the scaphoid is broken.

Sometimes, the screw or wire can be placed in bone fragments with a small incision. In other cases, a larger incision is needed to ensure that the fragments of the scaphoid line up properly.

In cases where the bone is in more than two pieces, a bone graft may be needed to aid in healing. A bone graft is new bone that is placed around the broken bone and is used to stimulate bone healing. It increases bone production and helps broken bones heal together into a solid bone.

This graft may be taken from your forearm bone in the same arm or, less frequently, from your hip.

Care:

Whether your scaphoid fracture requires surgery or not, you will need to wear a cast or splint while the fracture heals. This may be for as long as 6 months. Avoid heavy lifting, carrying, pushing, pulling, or throwing with the injured arm

  • Do not participate in contact sports

  • Do not climb ladders or trees

  • Avoid activities with a risk of falling onto hand (for example, inline skating, jumping on a trampoline)

Some people have wrist stiffness after scaphoid fractures. This is more common when a cast was needed for a long time or when the fracture required more extensive surgery.

It is very important to maintain full finger motion throughout the recovery period. Dr. Parikh and his team will provide an exercise program, and may recommend hand therapy to help you regain motion and strength in your wrist.

Even with therapy, some people do not recover the same motion and strength in their wrists that they had before their injuries.

Complications

Nonunions

A bone that fails to heal is called a nonunion. Nonunions are more common after scaphoid fractures because blood supply to the scaphoid bone is poor. Blood supply to the bone is very important in its healing. Bones need blood to carry oxygen and nutrients to the site of the fracture.

If the scaphoid does not heal, your doctor may consider surgery to apply a bone graft. As mentioned above, many kinds of bone graft can be used. A bone graft may be taken from a bone in the forearm or the hip, Sometimes a special kind of bone graft with its own blood supply (vascularized graft) may be used.

Avascular Necrosis

When the scaphoid is broken, especially when the fragments have moved apart (displaced), the blood supply to those fragments may be disrupted. Sometimes, the blood supply to one of the fragments is so poor that the piece does not get enough nutrients and the cells in that fragment die. This is called avascular necrosis. A bone graft with its own blood supply (vascularized graft) is the most effective treatment for this condition.

Arthritis

Over time, nonunion and avascular necrosis of the scaphoid can lead to arthritis of the wrist. Symptoms of arthritis in the wrist that results from scaphoid nonunion or avascular necrosis include:

  • Aching in the wrist

  • Decreased range of motion of the wrist

  • Pain with activities such as lifting or gripping

If x-rays show arthritis in the wrist as a result of an old break in the scaphoid, treatment focuses on improving the symptoms of arthritis. At first, this may include taking anti-inflammatory medicine and wearing a splint when the wrist is painful. Sometimes, Dr. Parikh and his team may inject a steroid into the wrist to help relieve wrist pain.

If this does not work, surgery may be recommended. Many types of operations can be performed for wrist arthritis.


Information obtain from www.orthoinfo.aaos.org