Wrist Fractures

A wrist fracture is a crack or complete break in one of the bones at the wrist, most often the end of the forearm bone on the thumb side. A break that stays in place can often heal in a cast, while one that has shifted out of position may need to be reset or held with surgery so it heals in good alignment. One small wrist bone, the scaphoid at the base of the thumb, deserves special attention: its blood supply enters from one end, so a break in the wrong spot can leave part of the bone unable to heal. That is why a wrist that stays tender at the base of the thumb after a fall is taken seriously even when early X-rays look normal.

Common symptoms include:

• Sharp wrist pain, swelling, and bruising right after a fall onto the hand
• Difficulty gripping or putting weight through the wrist
• A bent or deformed appearance with a badly shifted fracture
• Tenderness in the small hollow at the base of the thumb, which points to the scaphoid
• Numbness or tingling in the thumb, index, and middle fingers if a fragment presses on the nerve

Evaluation begins with an exam that checks where the wrist is tender, inspects the skin, and confirms the nerves and circulation to the hand are working. X-rays confirm most fractures and show how much the bone has shifted. For a suspected scaphoid injury with normal X-rays, the wrist is splinted and re-imaged later, or an MRI is used to find it sooner. A CT scan helps plan repair when the break enters the joint surface.

Stable fractures in good position are usually treated without surgery:

• A cast or removable splint, with a thumb-spica cast worn longer for scaphoid fractures
• Closed reduction to realign a shifted fracture without surgery and hold it in a cast
• Follow-up X-rays to confirm the bones have not drifted out of position
• A gradual return to pushing and lifting once the bone is ready

Surgery is considered when the fracture cannot be held in acceptable position, enters and misaligns the joint surface, compresses the nerve, or sits where the scaphoid's blood supply is most at risk. A displaced forearm-bone fracture is commonly held with a plate and screws, and a scaphoid fracture with a single screw.

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Distal Radius Fractures (Broken Wrist) — AAOS OrthoInfo