Hand and Wrist Information Center
	Our Specialist Physicians:	B.J. Luskin, MD

The Broken Wrist Brandon J. Luskin, M.D.

A broken wrist is amongst the most common of injuries treated by orthopaedic surgeons. The majority of these fractures occur at the distal end of the radius. This is the portion of the bone where it widens and is usually softer and more fragile than the shaft of the bone. Many of these fractures have an associated injury to the distal end of the ulna. At the end of the radius, there are eight carpal bones which enable us to flex and extend the wrist. There is a joint between the radius and ulna which enables us to rotate (pronate and supinate) the wrist. Added to this is a multitude of fibrous ligaments which hold each of these bones and joints together. Although we always seem to focus on the fracture, the soft tissue (ligamentous) portion of the injury can be equally problematic. Fractures of the wrist can be simple or complex. In general, the more fragmentation and the more parts of the wrist involved, the worse the outcome. Because there are so many bones and joints that must function in concert, the wrist is a fussy part of the body that can be very nonforgiving when injured.

The outcome of a broken wrist is determined by three variables. The outcome is the patient's subjective opinion regarding how well they have recovered from the injury. Fracture healing or "union" is almost never a problem in distal radius fractures. The problems after these injuries are usually due to 1) persistence of wrist pain, 2) loss of motion, or 3) deformity or visible difference in the wrist after it has finished healing. The function of the orthopaedic surgeon is to help the patient have the best scores in each of these categories. Although these injuries are so common, it is sometimes difficult to predict who will enjoy an excellent outcome, and who will have long-term problems. Treatment should be tailored not only to the x-rays, but also the patient's age, general medical status, and necessary functional demands.

Some fractures are rather simple and require basic protection in a cast for four to six weeks so that the patient does not bang, bump, or reinjure the fracture into a worse position. Other fractures require local or general anesthesia to "set" or restore skeletal alignment before casting. Unstable fractures would not hold this position with just a cast alone, so the doctor recommends additional treatment such as pins or plates and screws to hold the proper position while the fracture heals. Most fractures can have some tendency to settle (slip or shorten) over the following two to three weeks after they are set. It is difficult to determine how much they will settle ahead of time. This usually leads to some visual deformity and the loss of skeletal relationships may or may not have implications for pain and/or function.

In making my treatment recommendations to patients, I remind them that I am a physician, not a prophet! I utilize all of my previous experience when advising people of the best options for their fracture, however, this is not a perfect science. There are many people with final x-rays which look perfect yet have significant functional or comfort problems, and many patients with significantly less than perfect x-rays with no pain, no impairment, and they are hardly aware of the minimal deformity. Don't hesitate to ask your doctor questions about your specific injury.