Wrist Fractures

Fractures of the radius and ulna
The wrist joint is made up of the two bones in your forearm (the radius and the ulna) and the many tiny bones in the base of your hand (carpal bones). The radius is the bone on the thumb side of the forearm, and the ulna is the outer bone of the forearm located on the side of the pinky (Fig. 1). Fractures of these bones in the forearm are the most common wrist fractures in all age groups. These fractures generally occur during a fall on an outstretched hand. Children with these fractures may have only a small amount of swelling and deformity (the bone is out of its normal position). In adults, particularly the elderly, fractures near the wrist can cause a large amount of swelling and deformity. (Smith's fracture and Colles' fracture)

Treatment
The physician's first step in treating anyone with wrist pain after an injury is to obtain and evaluate an x-ray. This will usually be all the testing necessary to tell if a bone is fractured (broken, cracked, chipped, or smashed). Sometimes, however, more testing may be necessary (such as an MRI, CT, or bone scan) to help determine the best form of treatment.

The treatment of a wrist fracture varies widely and depends on its location, position, and stability, and how many pieces of broken bone have been created by the injury. Most fractures are treated simply with a cast; sometimes the bone fragments must be gently pushed back to a more normal position before casting. Some fractures are unstable enough that a cast cannot hold the pieces of bone in a normal position for healing, and surgery may then be necessary. Patients with wrist fractures usually do very well, although some may have problems with slight stiffness or loss of motion. Arthritis can also develop sometime in the future, particularly if the smooth, shiny joint surfaces were disrupted by the fracture pieces.

Scaphoid fractures
The scaphoid is one of the small carpal bones in the wrist that is occasionally injured by a fall on an outstretched hand (Fig. 2). It is the second most common wrist fracture and occurs almost exclusively in active young adults.

At its best, this is a slow-healing fracture, requiring an average of 3 months in a cast that extends over the thumb. At its worst, this fracture may require surgical treatment, such as bone grafting (taking bone from another part of the body or a donor).

No bones about it!
If you suffer from wrist or forearm pain, especially if you have experienced an injury, don't hesitate to see your physician. He or she will be able to provide the best form of treatment, which will allow you to return to your normal activities.

Steven Niergarth, D.O.
Milledgeville, Georgia