Wrist fractures are among the most common broken bones treated by orthopaedic surgeons. Most wrist fractures involve the distal radius, which is the larger of the two forearm bones at the wrist. Whilst many fractures heal well with a cast, some require surgery to restore the normal alignment of the wrist and achieve the best possible long-term function.
Mr Robert Farnell is an experienced specialist Consultant Orthopaedic Hand and Wrist Surgeon who has been working in Leeds for over 25 years. He exclusively treats conditions affecting the adult hand and wrist, including distal radius fractures, scaphoid fractures, complex wrist injuries and post-traumatic wrist arthritis.
What is a wrist fracture?
Although several different bones can be broken around the wrist, the vast majority of wrist fractures involve the distal radius. The distal radius is the end of the larger forearm bone where it meets the wrist joint.
In younger people, wrist fractures usually occur following high-energy injuries such as sporting injuries, cycling accidents or road traffic collisions. In people over the age of 50, the bone is often weaker because of osteoporosis and a fracture may occur following a simple fall onto an outstretched hand.
Symptoms of a wrist fracture
The symptoms usually develop immediately after the injury and commonly include:
- Severe wrist pain
- Swelling around the wrist
- Bruising
- Difficulty moving the wrist
- Visible deformity in more severe fractures
- Reduced grip strength
Some fractures are only minimally displaced and the wrist may simply feel painful and swollen. More severe injuries may result in obvious deformity.
How is a wrist fracture diagnosed?
Most wrist fractures can be diagnosed with a clinical examination and standard X-rays.
Occasionally further imaging is required. A CT scan may be used to assess complex fractures involving the joint surface or to help plan surgery. In some situations additional imaging can also identify fractures that are difficult to appreciate on standard X-rays.
Find out what to expect at your outpatient appointment.
Treatment for wrist fractures
Treatment depends on several factors including:
- The position of the fracture
- Whether the fracture extends into the wrist joint
- The stability of the fracture
- Your age and activity level
- The quality of the bone
Non-surgical treatment
Fractures where the bones remain in their normal position can usually be treated successfully in a cast.
During the first few days after the injury a half cast, often called a back slab, may be applied to accommodate swelling. Once the swelling has settled this is replaced with a full cast, which supports the wrist and forearm while allowing the fingers to move freely.
Most fractures have healed sufficiently by approximately six weeks, although complete recovery of strength and movement takes considerably longer.
Surgical treatment
Surgery is generally recommended for fractures where the bones have moved out of position or where the fracture is unstable.
Manipulation and application of a cast
Some displaced fractures can be realigned without making an incision. This is known as manipulation.
The procedure is performed after suitable pain relief such as local anaesthetic or inhaled analgesia. If a satisfactory position is achieved and the fracture is stable, a cast is applied.
Regular X-rays are usually performed during the first three weeks to ensure the fracture remains in a satisfactory position whilst healing occurs.
Manipulation and insertion of smooth pins (K-wires)
Some fractures can be manipulated successfully but remain unstable. In these cases smooth metal pins, known as K-wires, may be inserted through the skin in the operating theatre to hold the fracture while it heals.
A cast is normally worn for approximately six weeks. The wires are usually left protruding through the skin and can be removed in the outpatient clinic once healing has occurred.
Manipulation and application of an external fixator
An external fixator is another method of stabilising an unstable fracture.
Pins are inserted into the bone above and below the fracture and connected by a frame outside the skin. This maintains the alignment of the fracture while healing takes place.
The external fixator is usually removed in the outpatient clinic after approximately six weeks.
Open reduction and internal fixation
Some fractures cannot be satisfactorily treated by manipulation alone. This is particularly true for fractures involving the joint surface or more complex injuries in younger patients.
A surgical incision is made to accurately realign the fracture fragments. A specially designed metal plate and screws are then used to hold the fracture securely.
Because the fixation is stable, wrist movement can usually begin once the discomfort has settled, often within two weeks after surgery.
Recovery after a wrist fracture
Recovery continues long after the fracture has healed on X-rays.
It is common to experience stiffness, weakness and discomfort for several months. Most people steadily improve during the first year after injury, with smaller improvements continuing for up to 18 months.
Some patients benefit from hand therapy or physiotherapy to improve movement, strength and function, although many people regain excellent movement with a structured home exercise programme.
Read more about post-operative care.
Possible complications
Complications of surgery
- Infection (less than 1%)
- Tendon injury (uncommon)
- Nerve injury (uncommon)
- Blood vessel injury (uncommon)
Complications of the fracture
- Persistent wrist stiffness
- Reduced forearm rotation
- Carpal tunnel syndrome
- Post-traumatic osteoarthritis, particularly after fractures involving the joint surface
- Persistent wrist pain
- Tendon rupture, most commonly affecting thumb extension
- Malunion, where the fracture heals in an abnormal position
Prognosis
Distal radius fractures are common injuries and the majority of patients make a good recovery with appropriate treatment.
Although discomfort and stiffness are common during recovery, continued improvement can be expected for up to 18 months after the injury. The final outcome depends on the severity of the fracture, the treatment required and commitment to rehabilitation.
Broken your wrist?
If you have sustained a wrist fracture or would like a specialist opinion regarding treatment or recovery, Mr Robert Farnell can assess your injury and advise on the most appropriate management to help restore wrist function.
Wrist Fracture FAQs
What is the most common type of wrist fracture?
The majority of wrist fractures involve the distal radius, which is the larger of the two forearm bones at the wrist.
Can a broken wrist heal without surgery?
Yes. Many wrist fractures heal successfully in a cast if the bones remain well aligned.
When is surgery needed for a wrist fracture?
Surgery is usually recommended when the fracture is displaced, unstable or involves the wrist joint.
How long does a wrist fracture take to heal?
Most fractures heal within approximately six weeks, although recovery of strength and movement continues for many months.
Will I need physiotherapy?
Some patients benefit from physiotherapy or hand therapy, although many regain good function with a structured home exercise programme.
Can a wrist fracture cause arthritis?
Fractures involving the joint surface carry a greater risk of developing post-traumatic osteoarthritis later in life.
What is a distal radius fracture?
A distal radius fracture is the most common type of wrist fracture and affects the larger forearm bone where it meets the wrist.
When can I drive after a wrist fracture?
This varies depending on treatment, recovery and whether you can safely control a vehicle. Mr Farnell will advise when it is appropriate to resume driving.