Broken wrist

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

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A wrist fracture is understood to be a fracture of the spoke (one of the two forearm bones) near the wrist. The medical term is "distal radius fracture". Wrist fractures are the most common type of broken bones in adults. Mostly older people with osteoporosis (bone loss) are affected. Find out everything you need to know about the causes, symptoms, diagnosis and treatment options for a broken wrist!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. S62

Wrist fracture: description

A wrist fracture (distal radius fracture) is a fracture of the spoke (radius) that is up to three centimeters from the wrist. Three quarters of all patients have a simple broken spoke. In the last quarter, the joint surfaces are also affected by the injury, which can make healing difficult.

A wrist fracture accounts for around 25 percent of all fractures in adults, making it the most common type of fracture in this age group. Mostly people over 50 are affected, and then mostly women. In the under-50 age group, slightly more men than women suffer a broken wrist.

Greenwood fracture

Special forms of bone fracture occur in adolescents because the bones are still very elastic at this age. One of these special forms is the greenwood fracture - an incomplete break in which the outer layer of the bone (cortex) is still partially intact. At this point, the broken ends still "hang" together. The greenwood fracture occurs mainly in long bones. The distal radius fracture (wrist fracture) in children and adolescents can also manifest itself as a greenwood fracture - the spoke has not completely broken through.

Wrist fracture: symptoms

A broken wrist causes pain, especially when twisting the affected hand outward or twisting the forearm. Other possible symptoms are a visible deformity, swelling and sensory disturbances. The affected hand loses its strength and can no longer fulfill its full function.

Wrist fracture: causes and risk factors

In most cases, the cause of a broken wrist is a fall that you try to catch with your hand. As a rule, you land with the palm of your hand first on the floor, which results in a so-called extension fracture ("Colles fracture"): The hand is stretched on impact, the bone fragment near the wrist is shifted towards the back of the hand.

The hand is less often flexed on impact, so that the back of the hand comes up first. This then results in a flexion fracture ("Smith fracture"): the bone fragment near the wrist shifts towards the palm of the hand.

The distal radius fracture occurs mainly in older people because their bones have lost their stability due to wear and tear and mostly also due to osteoporosis (bone loss). In addition, older people often become more insecure and frail, are less agile and are less able to cope with falls. Then a fall from a standing position, for example in your own apartment or on the sidewalk, is often enough to break your wrist. Factors that increase the risk of falling (such as unsteady gait, visual disturbances, circulatory problems, cardiac arrhythmias) also increase the risk of a wrist fracture caused by a fall.

Younger people with their more stable bones, on the other hand, require more force to break such a bone - a dangerous fall, a traffic or sports accident.

Wrist fracture: examinations and diagnosis

If you suspect your wrist is broken, you should see an orthopedic and trauma surgeon doctor. He will first ask you exactly about your symptoms and how the accident happened (anamnesis). Possible questions are:

• Did you fall on the wrist?
• How exactly did the accident happen?
• Can you still straighten and bend your wrist?
• Do you have pain?
• Have you ever had any hand complaints such as pain, restricted mobility or a previous dislocation?
• Do you have any pre-existing conditions such as osteoporosis or osteoarthritis?

Then the doctor will examine your wrist carefully: He will check whether there is a malposition and whether careful palpation of different areas causes pressure pain. He looks for soft tissue injuries such as abrasions, bruises or hematomas (bruises) as well as possible accompanying injuries (for example on the ligaments and bones of the hand, on the arm and on the shoulder). He also checks the sensitivity and blood flow in the hand. A functional test is also important: the doctor tests whether the wrist and finger joints move actively and passively and whether the forearm can be rotated.

Wrist fracture: imaging tests

Anamnesis discussion and examination often result in a strong suspicion of a broken wrist. To confirm the diagnosis, the wrist is x-rayed in two planes. The X-ray examination is the standard method for clarifying a distal radius fracture.

Sometimes computed tomography (CT) can also be useful, for example if the doctor suspects additional injuries in the wrist area.

Magnetic resonance imaging (MRI) is performed in individual cases. This can be useful if the doctor suspects that ligaments or cartilage have also been injured.

As an exception, further examinations can be ordered, such as an ultrasound examination (sonography).

Wrist fracture: treatment

Treatment of a broken wrist aims to relieve pain and restore function, mobility and strength in the wrist and hand as quickly as possible. The patient is given medication (analgesics) to relieve pain. The further therapeutic measures depend on the type of fracture, possible accompanying injuries as well as the age and general condition of the patient. In principle, a broken wrist can be treated conservatively and surgically.

Wrist fracture: conservative treatment

Conservative treatment is chosen for an uncomplicated wrist fracture - i.e. a fracture in which no joint surfaces are involved and which is not or only slightly displaced. Such a fracture can easily be re-anatomically aligned correctly (repositioned). A greenwood fracture in adolescents is also usually treated conservatively.

The patients receive a support bandage (plaster of paris or softcast) for four to five weeks. The healing process is checked by means of X-rays after four, seven and 11 days.

Wrist fracture: surgical treatment

A complicated wrist fracture requires surgery. Doctors describe the following fractures as "complicated":

• Wrist fracture involving the joint
• Fracture that differs greatly at the fracture line
• open wrist fracture (ends of the broken bone protrude through the skin)
• Wrist fracture with major soft tissue damage and / or additional nerve or vascular damage
• Wrist fracture with complex accompanying injuries (such as damage to the adjacent ligaments)
• Wrist fracture with existing osteoporosis
• Wrist fracture that could not be successfully brought back into the correct anatomical position by conservative measures

The standard operative procedure for a wrist fracture is the so-called osteosynthesis with an angle-stable plate: With the help of this metal plate, the fracture is correctly aligned and stabilized again. The wrist is then immobilized for some time - for how long depends on the stability that was achieved through the operation. Immediately after the operation and after eight weeks, the break is checked on the X-ray.

Wrist fracture: follow-up treatment

The wrist fracture itself is immobilized for a long time, both with conservative and surgical treatment. The adjacent joints (fingers, elbows, shoulder) and the arm should, however, be moved at an early stage: A physiotherapist shows the patient suitable movement exercises. Even in everyday life, the fingers should be moved and used as normally as possible (despite a bandage or a plaster cast on the wrist), for example for grasping.

In order to avoid swelling, one should not let the arm droop if possible and place it on a pillow at night.

The plate implant used during the operation is removed after 12 months at the earliest. The exact time depends on individual factors such as local complaints and the age of the patient.

Wrist fracture: disease course and prognosis

A broken wrist often heals without any problems, especially in the case of stable fractures. In some cases, however, complications and long-term effects develop. These include:

• Limited mobility of the wrist and fingers
• Reduced strength of the wrist and fingers
• Misalignments of the wrist, deformities
• Movement and / or sensation disorders in nerve injuries
• Circulatory disorders with vascular injuries
• Delayed tilting of the fracture (the bone fragments shift and twist after attempting treatment)
• Healing is delayed or does not occur, so that the fracture does not ossify, but a "false joint" (pseudarthrosis)
• Osteoarthritis, when the wrist is involved in the fracture
• Carpal tunnel syndrome
• chronic pain
• Shoulder pain due to poor arm posture
• Complex Regional Pain Syndrome (CRPS, formerly also called Sudeck's disease)
• Rupture of the long extensor tendon of the thumb
• Implant loosens or moves

Patients who suffer from persistent or increasing pain or sensory disturbances after a broken wrist should see a doctor immediately so that possible complications can be recognized and treated at an early stage.

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