WRIST FRACTURE: Classification, Diagnosis and Treatment
By wrist fracture I mean a fracture of the lower end of the radius bone that forms the wrist joint.
This fracture is caused by a fall on the outstretched hand.
It is commonly seen in post menopausal females. In these females it occurs as a complication of osteoporosis. In young adults it is usually a result of high velocity trauma such as road traffic accidents.
This fracture is also known by many other names such as Colles fracture, Smith fracture and Barton fracture. Still sometimes doctors use these names to describe fractures of the lower end of the radius bone.
Wrist fracture can be classified into either
- Intra-articular fractures that extend into the wrist joint.
- Extra-articular that do not extend into the wrist joint.
Extra-articular are further divided into subtypes that
- Type 1 are undisplaced fractures (hairline)
- Type 2 - displaced and stable are those that do not re-displace after manipulation and re-alignment
- Type 3 - displaced and unstable are those that re-displace after manipulation and cast immobilization
Intra-articular fractures can be divided into the following subtypes
- Type 1 - undisplaced or minimally displaced with less than 2mm step in the joint line
- Type 2 - displaced and stable meaning that they do not re-displace after manipulation
- Type 3 - displaced and unstable as they re-displace after manipulation and cast immobilization
- Type 4 - displaced and irreducible as they can not be reduced by traction and require surgery due to presence of muscle or tendons between the fracture fragments
Diagnosis of wrist fracture is by history and local examination.
- history of trauma is present
- in elderly mechanism of injury is fall on the outstretched hand
- young people sustain this fracture in road traffic accidents, industrial accidents or fall from height
- in displaced fractures pain and swelling, deformity is seen
- deformity can be either "dinner fork" when the displacement is backwards
- "garden spade" when the displacement is forward
In undisplaced fractures there is no deformity only pain and swelling may be present. Patients may think they have wrist sprain and this may cause a delay in diagnosis.
The examining doctor should assess the function of the median nerve as it may be injured.
Investigations include x ray of the wrist in two planes. Additional oblique views may be required to determine the fracture anatomy and rule out fracture of the scaphoid bone.
Treatment of wrist fracture depends on the displacement and stability of the fracture.
- In Type 1 Extra-articular and Intra-articular fractures a plaster cast is applied for 4 weeks in elderly patients and up to 8 weeks in young adults.
- Type 2 Extra-articular and Intra-articular a plaster cast for 4 weeks in elderly and up to 8 weeks in young after alignment of the fracture with manipulation.
- Type 3 Extra-articular and Intra-articular either manipulation of the fracture with traction and stabilization with stainless steel wires if this is not satisfactory then the fracture is aligned after giving an incision and stabilized by plate and screws.
- Type 4 Intra-articular require surgery for alignment and stabilization of the fracture by an external frame or internal plate and screws or both together. Bone grafting is required, when after stabilization there is more than 2mm bone gap between main fracture fragments.
Complications of wrist fracture include
- malunion or union in a wrong position
- reflex sympathetic dystrophy
- carpal tunnel syndrome
- tendon rupture
- non-union or failure of the fracture to unite
Frequently Asked Questions
How long does the fracture take to unite?
The fracture usually takes 4 to 8 weeks
How long will it take to regain complete function in the wrist and hand after fracture union?
If there are no complications then it usually takes 4 to 6 months to regain complete movement and strength in the hand.
What exercises should I during and after treatment?
During treatment you should do the following exercises
- clench your fist as much as you can
- straighten your fingers as much as you can
- if complete active movement is not possible then the joints of the fingers should be passively moved through their full range of motion with the help of the uninjured hand
- move your shoulder through its full range of motion many times in a day
- it your plaster does not immobilize the elbow joint then it too should be moved through its full range of motion
After union of the fracture and you should continue doing all the above exercises and in addition you should start to move your wrist joint. As advised by your doctor you should also start using your hand. Initially you may require the services of a physiotherapist to get going.
What are the chances of non-union?
Chances of non-union are more if you have
- a Type 3 extra-articular or Type 4 intra-articular fracture
- gap between the fracture ends after manipulation and plaster
What is reflex sympathetic dystrophy and how is it treated?
Reflex sympathetic dystrophy is a condition characterized by
- sensation of cold or heat
- swelling followed by dryness
- sweating followed by dryness
- deformity may develop due to contractures
Treatment of this condition is difficult. It includes the following modalities.
- emotional support to the patient
- blocking sympathetic nerves
- physiotherapy is the most effective treatment that gives long term relief
This is a x ray of a 60 year old male who had sustained a extra-articular Type 2 wrist fracture after falling down. The bones in the x ray show a garden spade type of deformity.
After initial splinting a check x ray was done. Here in this x ray you can see the persistent displacement of the fracture. Due to this displacement of the fracture it was decided that the fracture would be aligned and splinted using fluoroscopy.
This is a photograph of the fluoroscopy screen showing the adequate re-alignment of the fracture.
I hope the information provided was helpful. If you have any query you can ask me at the contact me page.
This page was last updated on 30th March 2009.
Other causes of wrist pain...
De Quervain Disease
Carpal Tunnel Syndrome
Go back to Wrist Pain from Wrist Fracture