The wrist joint is made up of eight small bones. The long bones of the forearm called the radius and the ulna. The majority of a wrist fracture tend to occur in the distal part of the radius. The two most common types of fractures are a Colles fracture and a Smith’s fracture. A Colles fracture tends to occur due to a fall on an outstretched hand. A Smith’s fracture occurs in the opposite mechanism, when the hand is flexed forwards under the wrist. Severe trauma such as car accidents, falls and bicycle accidents tend to cause these types of fractures.
Fractures that are stable and non-displaced, are treated by placing the wrist in a cast or splint for 4-6 weeks. Unstable and displaced fractures often require surgery. Surgery allows the joint to heal in the correct alignment and restore full functional range of movement.
Wrist Fracture Surgery
Surgery is carried out as soon as possible on an unstable fracture, before healing can occur. The joint may be stabilised with internal fixation, whereby plates and screws are used to stabilise the joint and correct boney alignment. A small number of fractures may require external fixation.
The general rule for upper limb boney healing is to allow a 6 week period of immobilisation in a cast or splint to ensure proper bone strength. During this time it is important to care for and protect the wrist joint as appropriate, to ensure the best possible outcome and avoid complications.
Following surgery, the RICE principles of injury management apply. That is, the joint is rested, ice is applied to control swelling, a compression garment may be applied and the limb is elevated to also control swelling.
Any signs of infection such as redness, increased temperature, bad smells from the wound and leaking from the wound site should be noted. If any of these symptoms are present, it is important to present to your GP. Also possibly back to your orthopaedic surgeon to decide a course of action. This can be treated with a course of antibiotics. If more severe, the wound may need to be reopened and the wound site cleaned out.
Sometimes patients may try to itch their arm under the cast using a pencil or ruler. If doing this, sharp items which may break the skin should be avoided. If you were to open the skin, the likelihood of developing infection under the cast increase and may not always be noticed.
Also, do not forget about the rest of the arm. Regular range of motion exercises of the fingers, elbow, shoulder and neck should be performed to avoid stiffness and tightness of soft tissues through the upper limb.
Once the cast or splint is removed, range of motion and strength exercises can begin. This is an extremely important phase of wrist fracture healing and rehabilitation, and is where long term deficits may occur, if not treated correctly.
If you have had wrist surgery, and are ready to start mobilising and strengthening your wrist joint contact us here. Our physiotherapists can help improve joint range of motion, while providing you with a rehabilitation program to restore pre-injury function.