Broken wrist Kawititanga tāwhatiwhati o te ringa

You are most likely to break your wrist after falling and putting your hand out to try to save yourself. This is called falling on an outstretched hand.

Car and motorcycle accidents and falls from a ladder can cause more serious breaks.

Any of the bones in your wrist can break.

The most common one to break is the radius in your forearm. This is called a distal radius fracture.

Another common wrist fracture is a scaphoid fracture. This is a break in one of your small carpal bones. It can be difficult to diagnose, and there is a risk it might not heal. If it does not heal properly, you might get arthritis in your wrist in the future.

Your wrist can break in many different ways — some are worse than others. How bad it is depends on:

• how many pieces the bone breaks into
• whether they are stable or move around a lot
• whether the broken ends of the bone are still in the right place.

If any of your carpal or forearm bones break, it can change position slightly, causing pain and problems with movement and hand use.

• Your wrist will be painful and swollen.
• It may be hard to use your hand or wrist.
• Your wrist may look the wrong shaped because it is swollen or a bone is out of place.
• You may feel pain just where it is broken or whenever you move your fingers.
• Your fingers may tingle or your fingertips may be numb.

It is also possible you can still move or use your hand or wrist and assume you have just sprained it. The break may only be diagnosed some weeks later if you:

• see a healthcare provider because the pain is not going away
• cannot move your wrist as well as usual.

This is more common with a broken scaphoid bone.

If you think you may have broken a bone in your wrist, it is important to see a healthcare provider.

They will ask how your injury happened, look at your hand and request x-rays to find out which bone is broken and what kind of break it is.

Scans and x-rays

It can be difficult to see some wrist fractures on x-rays. You may need to have your wrist and hand in a cast and come back a week later for another x-ray.

They may also x-ray above and below where you are sore to check for other nearby injuries.

You may also have a CT scan. These show a complex break more clearly. An MRI scan can show any soft tissue injury as well.

If you have broken your wrist without any significant force, your healthcare provider may recommend bone density checks, to see if you have osteoporosis. If you meet the criteria, they may send you for a bone density scan.

Osteoporosis

Bone density scan (DEXA)

The way your broken wrist is treated depends on different factors, including:

• the type of fracture and whether the bones have moved or are unstable (meaning they could move out of position)
• whether a bone has broken through your skin (an open wound)
• how old you are
• your job, hobbies and activities
• whether your dominant hand is injured
• whether you have other injuries as well
• how good your overall health is.

Surgery for a broken wrist

You may need surgery to put the broken bone back into the right place and hold it there until it heals if:

• the break is unstable
• the bone has broken into many pieces
• the bone has broken where it forms a joint with another bone.

Healing a broken wrist in a cast

Simple breaks that are stable (the bones do not move around) usually do not need surgery. A cast will hold them in the right place while they heal. The cast will probably be from your knuckles up almost to your elbow. This helps keep your wrist bones in the right place while they heal.

If the ends of the broken bone are not properly lined up, your healthcare provider may need to move them back into place before you get your cast.

You will wear the cast for 4 to 6 weeks but can probably start doing some gentle hand exercises after 3 weeks.

You will still need to take special care of your hand and wrist once the cast comes off.

Care of your wrist and hand after a fracture

Sometimes a break seems to be stable and is put in a cast, but as the swelling goes down the broken bones move apart and need surgery to put them back in place. Having regular x-rays while your wrist is in a cast helps confirm the bones are the right place while they are healing.

There are things you can do to help your wrist heal, whether or not you are needing to have surgery.

• If you are a smoker, stop smoking. Smoking slows down the healing process.
• Do not do any heavy lifting or gripping with the injured hand. It will increase your pain and slow your recovery. You may need some time off work to let your wrist recover. It is important to keep using your hand lightly.
• Take regular pain relief as recommended by your healthcare provider. If you still have pain while taking the recommended pain relief, talk to your provider again. Do not take extra pain relief that has not been prescribed for you.
• Swelling can lead to further complications. To reduce the swelling, keep your wrist raised (elevated) above the level of your heart whenever possible. Also apply ice or a bag of frozen peas wrapped in a towel or plastic bag to your hand or arm above the cast — putting directly on your skin can burn it. Take care not to get the cast wet. Keep all your joints not in the cast moving – your shoulder, elbow, thumb and fingers.

Pain relief medicines for adults

Hand exercises while your arm is in a cast

Care of your cast

See your healthcare provider, hand therapist or physiotherapist as soon as possible if:

• you are in a lot of pain
• your wrist stays very swollen
• you cannot move your fingers well
• you are struggling to cope.

If you need surgery for your broken wrist, it will be done by an orthopaedic (bone) surgeon. What surgery you have depends the type of break. Your surgeon will talk to you about what it involves, the risks, benefits and how you are likely to recover.

The surgery will involve some metal (a plate, screws or possibly wires) to line up your bones properly and support them while they heal. Occasionally, the screws are held together with clamps and rods outside of the skin. It is usually temporary, to hold your bones in place while complex surgery is being planned.

Sometimes a wrist bone is so badly crushed that it leaves a gap when it is put back into place. If this happens, you may also need a bone graft, which is usually be done during surgery. If you need a graft, the bone will likely be taken from your radius (forearm) or, occasionally, from the hip.

You will probably spend 1 or 2 nights in hospital and your arm will be in a cast or splint for up to 6 weeks.

Recovering after surgery

You will need at least 2 weeks off work after surgery. How much time depends on:

• which bone was broken
• whether the break was in your dominant hand
• what your job involves
• whether there are any light duties you can do.

For a distal radial fracture (a break in your radius), you will probably need 10 to 14 days off work.

For a break in one of more carpal bones, you are likely to need between 3 and 10 weeks or more off work, depending on your job.

As you recover, you will have regular appointments with your surgeon and some x-rays to make sure your wrist is healing well. You will also need some physiotherapy to strengthen your hand and get it moving again.

Wires and metal clamps and rods usually need to be removed once you have healed. Exactly when depends on how bad your break was and how quickly your bones heal.

For metal wires underneath the skin, you will need another operation to take them out. If they are poking out of your skin, they will be removed at a clinic appointment. You will be given pain relief (such as laughing gas) or a local anaesthetic, which numbs the area.

Self care after surgery

For 2 to 3 months after surgery, you will not be able to lift or carry anything with the affected hand. You should also avoid sport or any other activity that may make your injury worse. Your surgeon will let you know when it is safe to start doing these things again.

If you have wires that are poking out from the end of your wrist it is important to protect them from becoming caught on clothing or anything else. You could accidentally pull the wires out this way. This would be painful and you might need repeat surgery to put them back in. It can sometimes mean you do not heal as well as possible and your hand will never work as well as it could.