The Wrist Fracture

What is a wrist fracture?

The wrist joint (see image) is made up of three main bones: the radius, the ulna and the three carpus bones. The most commonly fractured bone of the wrist is the lower extremity of the radius, which forms part of the wrist.

The two types of fractures of the lower radius extremity

Colle’s Fracture is the most common wrist fracture. As shown in the illustration, this fracture is caused by a fall on the inner hand, with the wrist outstretched. It is easy to see why Colle’s Fracture is the most common, since we tend to position our wrists outward to protect ourselves when falling down. When this type of fracture occurs, the bone is displaced in the direction opposite that of the outstretched hand. Colle’s Fracture  tends to be more common in women over 50 years old (due to bone density loss) than men, as well as in younger men who practice sports.

Contrary to Colle’s Fracture, Smith’s Fracture occurs when falling on the outer surface of the hand, which displaces the bone inward (as illustrated).  This is much less common than Colle’s Fracture. It is more common in men than women and causes less pain and stiffness in the fingers.

The Symptoms

• Intense pain at the wrist and fingers;
• Marked oedema;
• Wrist deformity, which shows up as a protuberance of the fractured bone (see illustration), and as a displacement or deformity of the hand as related to the forearm;
• An incomplete dislocation (subluxation) of the radius and ulna may also occur.

Medical Treatment

In the case of “simple” fractures, where the bone’s displacement is minor, the wrist will be immobilized in a cast for four to six weeks.

If the bone displacement is significant, or in the case of an open fracture, surgery is necessary to stabilize the fracture by internal (plates and screws) or external (staples) fixation; the wrist then needs to be immobilized four to twelve weeks.

It is very important during the immobilization period to keep the forearm in an elevated position as much as possible and to mobilize the joints outside the cast. This helps improve blood circulation, reduce the oedema, maintain range of motion and keep the non-cast joints mobile.

Late Complications

The two most common late complications of wrist fractures are algoneurodystrophy and malunion:

• Algoneurodystrophy is  a painful joint syndrome due to a disturbance in blood circulation and nerves, characterized by a marked oedema and shiny skin; it is also known as the “shoulder-hand syndrome”;
• Malunion is a misalignment of the bone.

The following complications can also occur:

• Persistence of the oedema;
• Stiffness of the fingers;
• Persistent deformity;
• Adhesive capsulitis of the shoulder due to arm immobilization;
• Arthrosis of the wrist;
• Persistence of the incomplete dislocation (less common);
• Rupture of the long extensor of the thumb’s tendon.

Physiotherapy Treatments: Avoiding Complications

Physiotherapy treatments can begin once the immobilization period is over. The goal is to reduce pain, lessen the oedema at the wrist and fingers, increase mobility and strength and restore function. It’s very important to seek physiotherapy treatments, because they can help avoid late complications; the treatments can include:

• Ice, contrast baths (hot and cold) to decrease pain and lessen the oedema caused by poor circulation;
• TENS to lessen pain;
• Whirlpool baths and paraffin baths to relieve pain and stiff joints;
• Manual therapy (passive stretching, contraction-release and gliding with traction);
• Strengthening of the wrist and gripping exercises;
• Functional exercises (practicing everyday activities, such as buttoning a shirt, combing hair, etc.);
• Recommendations are made regarding usage of the hand, depending on pain and capacity;  for example, the physiotherapist may recommend maximum usage of the hand, while respecting the pain threshold;
• Teaching a home exercise program and explaining the potential occurrence of late complications.

Prognosis

It’s important to begin physiotherapy treatments as soon as possible after the immobilization period to avoid ankylosis and stiffness of the wrist and fingers, and to help prevent complications. Physiotherapy can greatly improve recovery during the six months following immobilization. A slight loss of mobility (a few degrees of range of motion) can occur, mostly during wrist extension movements; however, the wrist will become functional in all activities.

Remember: the faster you get treatment, the better your chances of success!

Contact our physiotherapists if you need more information.