A wrist fracture is a break in one or more of the bones in the wrist. The wrist is made up of the two bones in the forearm (radius and ulna) and eight carpal bones. The carpal bones connect the end of the forearm bones with the bases of the fingers.
The two most common wrist fractures are:
Most of the time, a broken bone is obvious. The area around the break may be painful, swollen, or deformed. But sometimes a bone can break without your realizing it. That’s usually what happens to the scaphoid bone in your wrist. Many people with a fractured scaphoid think they have a sprained wrist instead of a broken bone because there is no obvious deformity and very little swelling.
Scaphoid fractures account for about 60 percent of all wrist (carpal) fractures. They usually occur in men between ages 20 and 40 years, and are less common in children or in older adults. The break usually occurs during a fall on the outstretched wrist. It’s a common injury in sports and motor vehicle accidents. The angle at which the wrist hits the ground determines the injury. If the wrist is bent at a 90-degree angle or greater, the scaphoid bone will break; if the angle is less than 90 degrees, the lower arm bone (radius) will break.
The scaphoid bone is located on the thumb side of your wrist, close to the lower arm bones. It is shaped like a cashew nut. The blood supply to the bone enters from the top, but most fractures occur in the middle or lower portion of the bone. This presents a problem because the blood supply cannot reach the injury to encourage rapid, adequate healing.
Risk factors that increase your chances of fracturing your wrist include:
Symptoms of a fractured wrist include:
If you’ve fallen and think you’ve sprained your wrist, see your doctor as soon as possible. Your physician will ask you to describe what happened, examine your hand and wrist, and order x-rays of the area. Unless the fracture is displaced (the bone ends no longer touch each other), it may be difficult to see a scaphoid fracture on the first set of x-rays.
Even if the initial x-rays do not show a scaphoid fracture, your physician may immobilize your wrist in a cast or splint for a week or so.
A bone scan taken two or three days after the injury can confirm the diagnosis, or your physician may request a second set of x-rays after a week to ten days. Other diagnostic imaging tests that may be used include magnetic resonance imaging (MRI) scan and computed tomography (CT) scan.
Treatment will depend on the severity of the injury. Treatment involves:
Devices that may be used to hold the bone in place while it heals include:
The doctor may prescribe pain medication depending on the level of pain. Your doctor will order more x-rays while the bone heals to ensure that the bones have not shifted position.
Healing time can range from six weeks to six months. After the cast is removed, a rehabilitation program helps restore range of motion and strength.
Any delay in getting a diagnosis increases the risk of poor healing and the probability of more problems later. An untreated scaphoid fracture can lead to severe arthritis and eventually require surgery to fuse or replace the joint.
To help prevent a wrist fracture:
Since wrist fractures are nearly always results of falls or other accidents, there is not much that can be done to prevent them. However, there are steps you can take to aid in the prevention of fractures:
The key to improving sports performance after recovering from a wrist fracture is a proper a rehabilitation program, and adhering to some of those same principles after the injury is gone.
The single most important aspect of improving performance is stretching before and after you step onto the field, court, ice, or golf course.
Benefits derived from stretching include:
As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important.
When your doctor decides you are ready, start range-of-motion and strengthening exercises. You may be referred to a physical therapist to assist you with these exercises.
Remember: Do not return to sports until your wrist is fully healed. The major objectives of rehabilitation from a wrist fracture are to improve the elasticity of the wrist joint and to gradually increase pain-free range of motion in the arm, hand, and fingers. The exercises below stretch the muscles of the forearm and upper arm. These exercises should be performed once or twice daily.
The following exercises develop strength of the muscles of the forearm and upper arm. To maintain symmetry of the arms in terms of strength and appearance, perform these strength exercises with the uninjured arm as well as the injured arm.
The following exercises may aid in restoring strength and range of motion to the hand, especially in cases where immobilization of the fingers and/or thumb is required.
During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:
Keep in mind that if your wrist fracture requires surgery, the soft tissue needs time to heal before exercise can begin.
A physical therapy program usually begins with range-of-motion and resistive exercises, then incorporates power, aerobic and muscular endurance, flexibility, and coordination drills.
Finally, patients develop speed and agility through sport-specific exercise routines.
The ultimate goal of surgery for a wrist fracture is to put the pieces of bone together so that they heal themselves. This will help provide dynamic stability while maintaining full range of motion, so that athletes can return to competitive or recreational sports. Progress is assessed by the patient's perception of how stable the wrist feels and by comparing the strength and stability of the injured and uninjured arms.,/
It takes 6 to 10 weeks for a fracture of the radius at the wrist to heal. A fracture of the scaphoid bone may take 10 to16 weeks to heal.
You may safely return to your sport or activity when the bones are healed and you have full strength and range of motion in the injured wrist compared to the uninjured wrist.
Some may be ready for full participation in six weeks, others not for four months or more. Of course, time for return to activity is much longer if surgery is necessary.
Remember: The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your wrist fracture recovers, not by how many days or weeks it has been since your injury occurred.