WHAT YOU SHOULD KNOW
The main supportive bone for the wrist is called the radius. It is one of the most commonly fractured bones in the entire body, usually by falling while reaching out with the hand. Sometimes the break is only into 2 simple pieces, but usually it is into many pieces. A very important distinction is fractures that split the cartilage of the joint surface that may lead to early arthritis. Often wrist ligament injuries accompany distal radius fractures. Sometimes the median nerve at the carpal tunnel is compressed by fracture swelling. Serious loss of function results when these injuries do not heal in the anatomically correct position.
MEDICAL HISTORY
Patients report injuries as simple as tripping on the curb to falling 2 stories off a building. Pain, swelling, stiffness, and sometimes numbness are the typical symptoms.
EXAMINATION
The doctor will check that nearby tendons and nerves are working correctly. Any examination that can be done for stability will be confined to what the patient tolerates with reasonable comfort.
ADDITIONAL TESTS
Plain x-rays give all the needed information regarding the fracture. They do not tell the whole story about potential ligament injury. Only direct examination of the ligaments under stress while viewing with the arthroscope can accomplish an accurate evaluation of ligament injury.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL STABILIZATION | |
| CONSISTS OF | Splinting then casting | Fix joint surface like jigsaw puzzle, support in correct position with titanium device, repair any damaged ligaments |
| FEATURES | Stays on 5-6 weeks | Minimally invasive fiber optic camera to do work in the joint. Open incision to place plate and screws to support bone, possible nerve decompression, removable splint |
| ADVANTAGES | Avoids surgery | Stable fixation allows early motion and assurance that all injuries have been treated |
| DISADVANTAGES | Cannot prevent an unstable fracture from shifting out of place | Invasive procedure |
RECOVERY
After surgery therapy begins the next week to initiate motion rehabilitation. The fracture itself will cause significant stiffness. The sooner and better the rehabilitation, the better the final function. Pins that are left through the skin in the forearm bones to prevent rotating the forearm will be removed in 4 weeks. Pins buried under the skin to support wrist ligament damage will be removed under a local anesthetic at around 8 weeks following surgery. The main plate and screws do not need to ever be removed. A lightweight removable splint is fashioned by the therapist. The patient must be diligent about doing hourly motion exercises to regain the best function possible. Bone healing is usually complete in 8-10 weeks after surgery. Further gains in motion and strength will occur up to a year.
