Broken Wrist/Broken Hand

A broken wrist or broken hand is either a break or crack that occurs in one of the many bones present in your wrist and hand.

Wrist fractures often occur when people try to catch themselves during a fall and land hard on an outstretched hand. Non-displaced wrist fractures in which the bones do not move out of their place are stable.

In displaced fractures, the bones should be put back in their place through a procedure called reduction. Otherwise, the displaced bones cannot heal with proper alignment, which affects your ability to do your routne activities such as grasping a pen or even buttoning your shirt.

It is important to treat a broken wrist as early as possible. Sometimes, fractures may result in breaking of the smooth surface of the joint or shattering into several pieces (comminuted fractures), which makes the bone unstable.

These are severe injuries and often need surgery to restore their alignment. Risk factors for a broken wrist or broken hand range from participation in certain sports activities such as in-line skating or snowboarding to having a condition in which your bones more fragile (osteoporosis).

Early treatment will also help minimize pain and stiffness.

When you have a broken wrist or broken hand, you may experience the following signs and symptoms:

• Immediate severe pain around the break that becomes worse with finger movements such as gripping or squeezing
• Swelling
• Tenderness
• Bruising
• Obvious deformity, such as a bent wrist or crooked finger
• Stiffness or difficulty to move or use your fingers or thumb
• Tingling or numbness at your fingertips

When to call a doctor

If you have a broken wrist or hand, see your doctor immediately, especially if you develop numbness, swelling or difficulty in moving your fingers.

A delayed diagnosis and treatment can lead to

• poor healing,
• decreased range of motion,
• reduced grip strength.

A direct blow or crushing injury to your hands and wrists can break any of the bones in them. Common causes include:

Falls

Falling down onto an outstretched hand is one of the most common causes of a broken wrist or broken hand.

Sports injuries

Many wrist or hand fractures occur during contact sports or sports in which you might fall onto an outstretched hand — such as in-line skating or snowboarding.

Motor vehicle accidents

High-velocity trauma that occurs during motor vehicle crashes causes wrist or hand comminuted fractures, which requires surgical repair.

Weakened bones due to disease such as osteoporosis tend to break more easily.

The diagnosis of a broken wrist or hand is done by several tests.

If your wrist injury is not very painful and there is no deformity, you may wait till the next day to see your doctor.

Meanwhile, you can protect your wrist with a splint. Place an ice pack on your wrist and keep it in an elevated position until your doctor examines.

If your wrist fracture is severely painful, and if there is any deformity, numbness or paleness in the fingers, you need immediate medical treatement in an emergency room or urgent care clinic.

You may be referred to a doctor who specializes in orthopedic surgery if the fragments of the broken bone are misaligned.

What you can do

You may prepare a list that includes:

• Detailed description of your symptoms and how the injury took place
• Information regarding your past medical conditions
• Information about the health conditions of your parents or siblings
• All the regular medications and dietary supplements you take

Questions you may want to ask the doctor

Prepare a list of questions you want to ask your doctor in advance in order to save some time during your appointment for issues which need to be discussed in detail.

For broken wrist or broken hand, some basic questions to be asked to your doctor include:

• What kind of tests will I need?
• What is the best course of action?
• Will I need to undergo surgery?
• Will I need a cast? If so, for how long?
• Will I need physical therapy after removal of the cast?
• Are there any restrictions that should be followed?

What to expect from your doctor

Your doctor may ask some questions such as:

• How did you injure yourself?
• Was your wrist or hand bent forwards or backwards during the impact?
• Are you a right-handed or left-handed person?
• Where exactly does it hurt, and is there any specific movement that improves or worsens your pain?
• Did you have hand or wrist injuries or surgery in the past?

The diagnosis of a broken wrist or hand usually includes a physical examination and one or more imaging tests.

Physical examination

During the physical examination, your doctor will examine the affected area for the following signs:

• Tenderness
• Swelling
• Range of motion
• Deformity
• Open wound
• Nerve damage
• Impaired blood flow

Imaging tests

Imaging scans are important in the diagnosis of a broken wrist or broken hand. To diagnose your injury, you may have:

X-ray

X-rays are a good tool to visualize bone as they can show if there is a crack or break in the bone, and also reveal bone displacement. X-rays are painless and take only a few minutes to complete.

CT scan

CT scans can show wrist or hand fractures that X-rays often miss. Injuries to soft tissues and blood vessels are also revealed on CT scans.

Magnetic resonance imaging (MRI)

MRI scan produces detailed images of bone as well as soft tissues using radio waves and a powerful magnet. Being very sensitive than X-rays, it can identify minute cracks and ligament injuries.

The treatment plan for broken wrist or hand depends on factors such as:

• Fracture type: whether displaced, unstable or open
• Your age, work, hobbies, activity level, and whether the affected one is your “dominant” hand
• Your overall health condition and presence of other injuries

If the broken ends of the bone are out of alignment, your doctor will need to manipulate the bone fragments to bring back to their proper positions. This process is called fracture reduction. Depending on the severity of your pain and swelling, you may be given a muscle relaxant, a sedative or even a general anesthetic before this procedure.

Immobilization

This involves restriction of the movement of a broken bone in your wrist or hand, which is important for proper healing. To do this, a padded splint may be worn initially to align the broken bones and provide support to the wrist. If the fracture seems to be stable, a cast may be placed to hold the fracture that has been reduced.

Medications

To control the pain, your doctor may advise to take an over-the-counter pain reliever, such as

• acetaminophen (Tylenol, others),
• ibuprofen (Advil, Motrin IB, others)
• naproxen sodium (Aleve, others).

If the pain is very severe, you may need an opioid such as codeine.

Therapy

You will need rehabilitation exercises or physical therapy once your cast or splint is removed in order to decrease the stiffness and restore movements in your wrist and hand. Rehabilitation is helpful, but may take several months — or even longer — for complete healing of severe injuries.

Surgical treatment and other procedures

In displaced fractures, where immobilization is not an option, you may require surgery to implant internal fixation devices, such as

• pains,
• plates,
• rods or screws

to maintain proper position of your bones during the healing period. These internal fixation devices are indicated if you have the following injuries:

• Multiple fractures
• An unstable, displaced fracture
• Loose bone fragments that may enter a joint
• Damage to the surrounding soft tissues and ligaments
• Fractures that involves a joint

If the bone has been severely crushed during injury, a gap remains in the bone even though it has been realigned. In such cases, a bone graft may be used to aid healing of the bone.

In some cases, the surgeon may use an external fixation device to immobilize your fracture. This device consists of a metal frame with two or more pins that go through your skin and inserted into the bone on either side of the fracture.

It is often impossible to prevent the untoward events caused by a broken wrist or broken hand.

Here are some basic tips that may offer some protection.

• Build bone strength
• You can build strong bones by:
• Intake of a nutritious diet rich in calcium and vitamin D
• Getting adequate weight-bearing exercise, such as brisk walking
• Stopping smoking if you are a chronic smoker

Preventing falls

Most broken wrists occur as a result of a fall forward onto an outstretched hand.

To prevent this type of injury, you should:

• Wear appropriate shoes
• Get rid of home hazards
• Keep your home well-lit
• Get your vision checked
• Install grab bars in your bathroom
• Install handrails on your stairways
• Avoid walking on slippery surfaces such as snow- or ice-covered walkways

Use protective gear during athletic activities

Wear wrist guards while participating in high-risk activities such as

• in-line skating,
• snowboarding,
• rugby,
• football

Lifestyle modifications are necessary in order to cope with broken wrist or broken hand.

While you recover from broken wrist, it is necessary to keep your fingers moving so as to prevent them from being stiff.

Your surgeon will advise you the right time to start moving your wrist. Hand therapy is helpful in

• recovering motion,
• strength,
• function.

The time required for recovery differs in each person, and some people may take several months.

Active participation in certain sports activities or presence of certain diseases may increase your risk of having a broken wrist or broken hand.

Sports activities

Certain activities may increase your risk of breaking your wrist bones. These include:

• Basketball
• Football
• Rugby
• Wrestling
• Hockey
• Skiing
• Snowboarding
• In-line skating
• Jumping on a trampoline

Health conditions

You may be more susceptible to broken wrist or hand if you:

• Have osteoporosis or other bone thinning diseases
• Are a chronic smoker as smoking affects the calcium absorption
• Take food that is deficient in bone-building calcium and vitamin D

Complications rarely occur with a broken wrist or broken hand, but these may include:

Ongoing stiffness, aching or disability

Generally, stiffness, pain or aches in the affected part disappears within a month or two after your cast is removed or after surgery. Your condition continues to improve for up to two years after the injury.

If the injury was very severe, however, you may have some permanent stiffness or aching. Be patient during your recovery, and your doctor will teach you some exercises that might help or refer you to a physical or occupational therapist.

Osteoarthritis

Fractures that involve the joint may lead to arthritis after some years. If you develop pain or swelling in your wrist or hand after a long time, consult your doctor for an evaluation.

Nerve or blood vessel damage

Wrist or hand trauma can injure the adjacent nerves and blood vessels. Seek immediate medical attention if you notice any numbness or other circulation problems.