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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.
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