How is a wrist fracture treated?
Treatment of fractured bones follows one basic rule: the fractured pieces must be put back into position and prevented from moving out of place until they are healed.
There are many treatment options for a distal radius fracture. The choice depends on many factors, such as the nature of the fracture, your age and activity level, and the surgeon's personal preferences.
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 fractured bone fragments. "Reduction" is the technical term for this process in which the doctor moves the fractured 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 is changed 2 or 3 weeks later as the swelling goes down more, causing the cast to loosen.
Depending on the nature of the fracture, your doctor may 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.
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, there are a number of options for holding the bone in the correct position while it heals:
- 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, your doctor may apply a temporary external fixator. Internal fixation with plates or screws may be utilized at a second procedure several days later.
What is recovery from a wrist fracture like?
Because the kinds of distal radius fractures are so varied and the treatment options are so broad, recovery is different for each individual. Talk to your provider for specific information about your recovery program and return to daily activities.
Most fractures hurt moderately for a few days to a couple of weeks. Many patients find that 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.
Your doctor 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, your doctor may suggest a prescription-strength medication, such as an opioid, for a few days.
Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.
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 or until the sutures (stitches) are removed, whichever occurs later.
What are some complications caused by a fractured wrist?
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 your doctor for evaluation.
Your doctor may loosen your cast or surgical dressing. In some cases, working with a physical or occupational therapist will be required to regain full motion.
Unrelenting pain may be a sign of Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy) which must be treated aggressively with medication or nerve blocks.