Articles

Seasonal Injuries

A Winter Hazard: The Wrist Fracture

By Lawrence H. Schneider, MD
Reprinted here from the Winter/Spring 1998 "First Hand News"

Picture this: you’re walking down the street and you suddenly slip on an icy patch. You put out your hands to break your fall. And instead, you break your wrist. Whether you’re skiing or ice skating or simply walking in your neighborhood, the ‘slip and fall’ often results in a wrist fracture, or fracture of the radius.

There are many types of wrist fractures. The most common fracture is called a Colle’s fracture. It is an injury of the long bone in the forearm-the radius — which breaks at the wrist level. When the wrist is forcefully bent backwards, and if the force is sufficient or the bone is very soft (as seen in the aged), the radius is broken.

Fractures that remain in place are easily and successfully treated with 4-6 weeks of immobilization in a cast. However if the ends of the bones are significantly displaced, they need to be manipulated back into place. Sometimes surgery is required to restore the continuity of the bone. Early evaluation by an upper extremity specialist is necessary to determine the extent of the injury.

Occasionally, even simple fractures interfere with functional use of the wrist and hand. Loss of wrist mobility and hand stiffness are not uncommon. Painful arthritis of the wrist can also occur. Other complications include nerve symptoms that result in numbness and tingling of the fingers. Proper application of the immobilizing device and expert supervision can limit possible complications.

With more serious fractures, expert evaluation prior to casting is even more critical. These ‘out of place’ fractures need close supervision after the cast is applied. In the case of fractures that enter or disrupt the wrist joint itself, more extensive treatment may be required. Surgical procedures like placing metal plates, screws or pins may be necessary. Sometimes a bone graft is required for proper healing.

The indications for more extensive treatment are also more important for younger, more active patients. In other words, the more functional demands the patient has, the more complex the treatment may be.

Finally, the importance of hand therapy under the supervision of a trained Hand Therapist cannot be understated. Proper therapy can be the difference between complete and incomplete recovery of function.

The distal fracture, even a simple one, requires expert evaluation at the onset of treatment. Once a treatment has been applied, the patient should be followed closely to make certain the bones remain properly positioned until healing is complete.

Sometimes you can’t avoid a winter hazard, but you can make sure you receive expert evaluation as soon as possible.