Understanding Wrist Fracture: Causes, Symptoms, Prevention, and Effective Treatments

▫️Written by John Keller

✅ Reviewed by Dr. Jenny Hynes on July 18, 2024

  1. What is a wrist fracture?

  2. Causes of wrist fractures

  3. Signs and symptoms of wrist fractures

  4. Prevention of wrist fractures

  5. Diagnosis of wrist fractures

  6. Treatment options for wrist fractures

  7. Role of physiotherapy for wrist fractures

  8. Conclusion

Wrist fractures, commonly resulting from falls or direct impacts, are among the most frequent types of fractures encountered in clinical practice. These injuries can significantly affect daily life, leading to pain, limited wrist function, and an extended period of rehabilitation. The prevalence of wrist fractures is notably high in older adults due to osteoporosis and in young, active individuals due to sports and high-impact activities (Court-Brown & Caesar, 2006; MacIntyre & Dewan, 2016).

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The impact of wrist fractures extends beyond the immediate pain and immobilization. They can lead to long-term functional impairments, affecting the ability to perform essential daily activities, such as writing, typing, and personal care. Effective management and rehabilitation are crucial to restoring wrist function and preventing complications such as stiffness, weakness, and chronic pain (Handoll & Madhok, 2003).

What is a wrist fracture?

A wrist fracture is a break or crack in one or more of the bones within the wrist. The wrist is a complex joint comprising eight small carpal bones, which connect to the two long bones in the forearm: the radius and the ulna. The most commonly fractured bones in the wrist are the distal radius, the distal ulna, and the scaphoid.

Anatomy of the wrist

The wrist joint is a highly flexible and intricate structure that allows for a wide range of motion. It consists of the following bones:

  • Radius: The larger of the two forearm bones, primarily responsible for the wrist's structural integrity.

  • Ulna: The smaller forearm bone, located on the inner side of the arm.

  • Carpal bones: A group of eight small bones that form the wrist and provide stability and flexibility. The scaphoid, located near the base of the thumb, is particularly prone to fractures (Ring & Jupiter, 2013).

Causes of wrist fractures

Wrist fractures can occur due to various reasons, including:

  • Falls onto an outstretched hand: This is the most common cause of wrist fractures, especially in older adults and children 

  • Sports injuries: High-impact sports such as football, basketball, and skiing often result in wrist fractures due to falls and collisions.

  • Accidents: Motor vehicle accidents and other traumatic incidents can lead to severe wrist fractures.

  • Osteoporosis: This condition weakens bones, making them more susceptible to fractures from minor falls or impacts, particularly in older adults (Cummings & Melton, 2002).

Risk factors

Several factors increase the risk of sustaining a wrist fracture:

  • High-impact activities: Engaging in sports or activities that involve a high risk of falling or impact.

  • Age: Older adults, especially those with osteoporosis, are at higher risk.

  • Medical conditions: Conditions like osteoporosis and rheumatoid arthritis can weaken bones and increase fracture risk

Signs and symptoms of wrist fractures

Typical signs and symptoms

Wrist fractures are often accompanied by several immediate signs and symptoms, including:

  • Pain: Intense pain at the time of injury, which can worsen with movement or pressure on the wrist 

  • Swelling: Swelling around the wrist and sometimes extending to the hand or forearm.

  • Bruising: Discoloration of the skin around the injured area due to internal bleeding.

  • Visible deformity: In severe fractures, the wrist may appear deformed or out of alignment (Rhemrev, Ootes, & Beeres, 2010).

Variation in symptoms

Symptoms can vary based on the type and severity of the fracture:

  • Simple fractures: May cause mild to moderate pain and swelling without significant deformity.

  • Compound fractures: These involve an open wound and may be accompanied by severe pain, visible bone fragments, and a high risk of infection.

  • Comminuted fractures: Multiple bone fragments can lead to severe pain, swelling, and a noticeable deformity (Nellans, Kowalski, & Chung, 2012).

Prevention of wrist fractures

Tips and strategies

Preventing wrist fractures involves several strategies:

  • Protective gear: Using wrist guards during high-risk activities like rollerblading or skateboarding can provide support and reduce the risk of fractures.

  • Proper techniques: Learning and maintaining proper techniques in sports and physical activities can minimize the risk of falls and impacts.

  • Home safety measures: Ensuring a safe home environment by removing tripping hazards and using non-slip mats can prevent falls, especially in older adults.

  • Bone health: Maintaining strong bones through a diet rich in calcium and vitamin D, along with regular weight-bearing exercises, can reduce the risk of fractures (Kannus et al., 2005).

Diagnosis of wrist fractures

Accurate diagnosis is crucial for effective treatment planning and involves several steps:

  • Physical examination: A thorough physical examination to assess pain, swelling, bruising, and deformity.

  • Imaging tests:

    • X-rays: The most common and widely used imaging technique to visualize bone fractures.

    • CT Scans: Provide detailed images of the bone structure and can help identify complex fractures.

    • MRI: Useful for evaluating soft tissue damage and detecting fractures not visible on X-rays (Richards & Goulet, 2010).

Importance of accurate diagnosis

An accurate diagnosis ensures that the appropriate treatment is planned, which can include immobilization, surgical intervention, and rehabilitation. Misdiagnosis or delayed diagnosis can lead to improper healing, chronic pain, and long-term functional impairments

Treatment options for wrist fractures

Non-surgical treatments

For less severe wrist fractures or those where the bones remain aligned (non-displaced fractures), non-surgical treatments may suffice:

  • Immobilisation: Using a cast or splint to hold the bones in place while they heal 

  • Pain relief: Anti-inflammatory medications such as ibuprofen or acetaminophen can help manage pain and reduce swelling (Ring et al., 2013).

Surgical options

Surgery may be necessary for displaced fractures or complex breaks that cannot be effectively treated with non-surgical methods:

  • Internal fixation: Involves using metal plates, screws, or wires to hold the broken bones in place while they heal (Ring & Jupiter, 2013).

  • External fixation: Uses a stabilizing frame outside the body to keep the bones aligned during healing, often used for severe fractures or when internal fixation isn't feasible 

Post-surgery care and recovery

Following surgery, recovery typically involves:

  • Immobilisation: Using a cast or splint initially to protect the surgical repair.

  • Physical therapy: Beginning gentle exercises to restore wrist mobility and strength gradually.

Role of physiotherapy for wrist fractures

Physiotherapy plays a crucial role in the rehabilitation of wrist fractures:

  • Rehabilitation: Physiotherapists design personalized programs to improve wrist range of motion, strength, and function.

  • Techniques and exercises: These may include gentle stretching, strengthening exercises, and manual therapy to reduce stiffness and pain.

  • Long-term benefits: Physiotherapy helps prevent long-term complications such as stiffness and weakness, promoting faster recovery and return to normal activities (MacIntyre & Dewan, 2016).

Conclusion

Understanding wrist fractures is essential for prompt diagnosis and appropriate treatment. Whether treated non-surgically or with surgery, seeking professional medical advice ensures the best outcomes. Physiotherapy plays a vital role in recovery, improving wrist function, and minimizing complications. Maintaining wrist health through proper care and rehabilitation can significantly enhance quality of life.

For those experiencing wrist pain or suspecting a fracture, consulting with a healthcare provider is crucial for accurate diagnosis and tailored treatment.

 

References:

  1. Court-Brown, C. M., & Caesar, B. (2006). Epidemiology of adult fractures: A review. Injury, 37(8), 691-697. https://doi.org/10.1016/j.injury.2006.04.130

  2. Cummings, S. R., & Melton, L. J. (2002). Epidemiology and outcomes of osteoporotic fractures. The Lancet, 359(9319), 1761-1767. https://doi.org/10.1016/S0140-6736(02)08657-9

  3. Handoll, H. H., & Madhok, R. (2003). Conservative interventions for treating distal radial fractures in adults. Cochrane Database of Systematic Reviews, (2). https://doi.org/10.1002/14651858.CD000314

  4. Canham, C. D., Schreck, M. J., Maqsoodi, N., Doolittle, M., Olles, M., & Elfar, J. C. (2015). A nondestructive, reproducible method of measuring joint reaction force at the distal radioulnar joint. The Journal of hand surgery, 40(6), 1138-1144.

  5. Kannus, P., Palvanen, M., Niemi, S., Parkkari, J., Järvinen, M., & Vuori, I. (2005). Fall-induced injuries and deaths among older adults. Journal of the American Medical Association, 293(20), 2631-2637. https://doi.org/10.1001/jama.293.20.2631

  6. MacIntyre, N. J., & Dewan, N. (2016). Epidemiology of distal radius fractures and factors predicting risk and prognosis. Journal of Hand Therapy, 29(2), 136-145. https://doi.org/10.1016/j.jht.2016.03.003

  7. Nellans, K. W., Kowalski, E., & Chung, K. C. (2012). The epidemiology of distal radius fractures. Hand Clinics, 28(2), 113-125. https://doi.org/10.1016/j.hcl.2012.02.001

  8. Rhemrev, S. J., Ootes, D., & Beeres, F. J. P. (2010). Current methods of diagnosis and treatment of scaphoid fractures. International Journal of Emergency Medicine, 3(1), 11-15. https://doi.org/10.1007/s12245-009-0116-7

  9. Richards, J. E., & Goulet, J. A. (2010). Fractures of the distal radius and ulna. In T. A. Einhorn, D. R. Marsh, J. P. Lane, & P. R. Rubin (Eds.), Orthopaedic Basic Science: Foundations of Clinical Practice (pp. 421-435). American Academy of Orthopaedic Surgeons.

  10. Ring, D., & Jupiter, J. B. (2013). Fractures of the distal radius. In R. W. Bucholz, J. D. Heckman, & C. M. Court-Brown (Eds.), Rockwood and Green's fractures in adults (pp. 829-886). Lippincott Williams & Wilkins.

 
 
 

Article by

John Keller

Clinical Director | Sports & Musculoskeletal Physiotherapist

John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.

 
 

Reviewed by

Dr. Jenny Hynes FACP

Clinical Director | Specialist Musculoskeletal Physiotherapist

Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.

 
 
John Keller