Overview

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:

• Colles fracture — a break near the end of the radius, an arm bone that forms part of the wrist joint
• scaphoid fracture — a break in the scaphoid, a bone located on the thumb side of the wrist where it meets the radius

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:

• advancing age
• postmenopause
• decreased muscle mass
• osteoporosis
• poor nutrition
• participating in contact sports, such as football or soccer
• participating in certain activities, such as inline skating, skateboarding, or bike riding
• violence

Diagnosis

Symptoms of a fractured wrist include:

• swelling and tenderness around the wrist
• pain and tenderness on the thumb side of the wrist
• bruising around the wrist
• limited range of wrist or thumb motion
• motion (gripping) may be painful
• pain may subside, then return as a deep, dull aching
• marked tenderness to pressure on the "anatomical snuffbox," a triangular-shaped area on the side of the hand between two tendons that lead to the thumb
• visible deformity in the wrist

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 Options

Treatment will depend on the severity of the injury. Treatment involves:

• putting the pieces of the bone together, which may require anaesthesia and/or surgery
• keeping the pieces together while the bone heals itself

Devices that may be used to hold the bone in place while it heals include:

• a cast (may be used with or without surgery)
• a metal plate with screws (requires surgery)
• screws alone (requires surgery)
• metal pins that cross the bone, with a metal splint on the outside of the wrist that holds the pins and the fractured bone in place (requires surgery)

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.

Prevention

To help prevent a wrist fracture:

• Do not put yourself at risk for trauma to the wrist bones.
• Eat a diet rich in calcium and vitamin D.
• Build strong muscles to prevent falls and stay agile.
• Wear proper padding and safety equipment when participating in sports or activities.

How can I 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:

• Eat a diet rich in calcium and vitamin D.
• Build strong muscles to prevent falls and stay agile.
• Wear proper padding and safety equipment when participating in sports or activities.

Improving Sports Performance

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:

• increased physical efficiency and performance
• decreased risk of injury
• increased blood supply and nutrients to joint structures
• increased coordination
• improved muscular balance and postural awareness
• decreased risk of lower-back pain
• reduced stress
• enhanced enjoyment

Wrist Fracture Rehabilitation

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.

Strengthening Exercises

• Wrist flexor stretch
  Extend affected arm forward with palm up and elbow straight. Place fingers and palm of opposite hand across palm and fingers of the extended hand and draw back with it until stretch is felt in the forearm. Hold this position for 3 to 5 seconds, then relax for 3 to 5 seconds. Perform this exercise 10 times.
• Wrist extensor stretch
  Extend affected arm forward with palm down, elbow straight, and fingers slightly curled. Grasp the affected side hand with other hand and draw affected side hand down until stretch is felt in the forearm. Hold this position from 3 to 5 seconds, then relax for 3 to 5 seconds. Perform this exercise 10 times.
• Pronation/suppination stretch
  Extend affected arm forward in a hand-shaking position with palm facing up. Slowly rotate the hand from a palm-up position to a palm-down position. Hold for 3 to 5 seconds and then rotate back. Perform this exercise 10 times. When you work your way up to strength training, you may use a small weight while rotating the hand and wrist.
• Tricep stretch
  Stand erect with feet at about shoulder width. Raise injured arm at the shoulder with elbow bent and place the forearm behind the head. Grasp the injured elbow with opposite hand and draw it toward the center of the body until stretch is felt. Hold this position for 3 to 5 seconds then relax for 3 to 5 seconds. Perform this exercise 10 times.
• Bicep stretch
  Stand erect with arms raised to shoulder height and palms up. Press arms backward until stretch is felt. Hold this position for 3 to 5 seconds then relax for 3 to 5 seconds. Perform this exercise 10 times. The bicep is stretched by this exercise as well as the muscles of the shoulder and upper chest.

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.

• Wrist extension
  Sit in a chair with forearm resting on the end of a table, palm down. Grasp a light weight dumbbell and raise the weight up as high as possible while maintaining contact with the table top. Hold this position for 3 to 5 seconds. Relax for 3 to 5 seconds. Repeat this exercise 5 to 10 times. Substitute a heavier dumbbell as strength increases.
• Arm curls
  Either standing or sitting, grasp a two- to four-pound dumbbell in one hand. With palm up, flex elbow and draw the dumbbell up to the same side shoulder while maintaining erect posture. Do not bend at the waist or swing the dumbbell. Lower dumbbell slowly and with control to the starting position. Repeat this exercise 10 times. Use a heavier dumbbell as strength increases.

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.

• Ball squeeze
  Place a tennis ball or equivalent in the palm of the injured arm and squeeze as forcefully as pain permits for five seconds. Slowly relax the hand. Rest for five seconds. Repeat 10 times at least three times a day. Generally, the more often the sequence can be repeated in a day, the better. From day to day, pain should subside until the point where the exercise can be done without pain.
• Finger extension
  Place hand, palm forward, on a wall or other flat surface. Press the palm toward the flat surface as fully as pain permits and hold for five seconds. Return to starting position and rest for five seconds. Repeat this sequence 10 times at least three times a day. Generally, the more often the sequence can be repeated in a day, the better. From day to day, pain should subside until the point where the exercise can be done without pain.
• Thumb extension
  While seated, place the elbow of the injured-side arm on the same-side thigh with the elbow at a right angle and fingers extended. Grasp the injured arm's thumb with the forefinger of the opposite hand. Gently draw back on the thumb, stopping at the point of pain. Hold the thumb in this position for 10 seconds, then release, and rest for 10 seconds. Do this sequence five times, three times per day. You should be able to draw the injured thumb back a bit further with each day.
• Thumb flexion
  While seated, place the elbow of the injured-side arm on the same-side thigh with the elbow at a right angle and fingers extended. Move the injured thumb inward so that the end of the thumb is brought as closely as first pain permits to the base of the small finger of the same hand. Hold this position for 10 seconds, then relax the injured thumb for five seconds. Perform this sequence 10 times, three times a day. From day to day it should be possible to press the injured thumb closer to the base of the same-side small finger. If not, see your doctor for advice.

Alternative exercises

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:

• brisk walking
• stationary bicycle

Rehabilitation after surgery

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.,/

How long will the effects of my injury last?

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.

When can I return to my sport or activity?

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.