There are different types and shapes of bones in the wrist that can break or “fracture.” Broken bones of the wrist can range from minor to severe depending on the type of bone involved and the degree of injury. Distal radius fracture of the wrist is the most common broken bone of the upper extremity. Distal radius fractures vary from simple non-displaced breaks in the bone to complex fractures with shattered bone and joints. In severe high energy injuries to the wrist, various patterns of ligament injuries and wrist dislocations can also occur together with broken bones.
Another bone of the wrist commonly broken is the scaphoid, a smaller peanut shaped carpal bone. Due to the scaphoid's unique shape, a non-displaced scaphoid fracture can be very difficult to identify on x-rays following initial injury and often can be misdiagnosed as a wrist sprain. Unfortunately, a scaphoid fracture left untreated will not heal (scaphoid fracture non-union) which ultimately leads to significant arthritis of the wrist, long term pain, stiffness, and weakness of grip.
A simple wrist fracture is a break in the bone that has minimal fragmentation of bone, minimal movement or shifting of bone out of position, maintains an overall good alignment, and remains stable. Most of these simple types of wrist fractures can be treated with a splint or a cast. Other important factors for determination of treatment include the location and pattern of the wrist fracture, involvement of the wrist joint, and activity level of the patient. If the wrist bones are fragmented or moved out of place, fracture manipulation or “reduction” of the broken bone may be done to reposition the bone. If the wrist fracture is repositioned well and remains stable, the fracture possibly can be treated in a cast. However, if the broken bone is unstable or shifts out of position, then surgery may be necessary to fix the wrist fracture.
Some broken wrists may be best treated with surgery to optimize functional outcomes. Depending on the type of bone fractured in the wrist, degree of injury, and patient factors, various types of surgeries are offered which may range from placing pins into the bone to fixing the bone with metal plates and screws (referred to as open reduction internal fixation). Most distal radius fractures that require surgery are fixed and secured with a distal radius volar plate and screws (see figures below). Scaphoid fractures that need surgery are typically fixed with a headless compression screw. Details of each type treatment, whether managed with or without surgery, are discussed in detail with each patient.
Dr. Mark A. Katz is a specialist with expertise in the treatment of wrist fractures. Dr. Katz has been a surgeon consultant for manufacturers who design plates and screws for distal radius fracture fixation, has lectured to surgical residents and fellows on distal radius fractures, and has participated in workshops teaching colleagues surgical techniques for fixation of distal radius fractures.