Signs and Symptoms
Symptoms usually start right after a fall or injury:
- Pain that is worse when you grip, squeeze or move the wrist
- Swelling, tenderness and bruising
- A visibly bent or deformed wrist
- Numbness or tingling in the fingers
- Pain in the hollow at the base of the thumb, which can signal a scaphoid fracture even when swelling is mild
Go to the emergency room right away if your wrist looks obviously deformed, your hand or fingers are numb, or bone has broken through the skin or there is an open wound near the injury.
What Causes It?
Most wrist fractures come from falling onto an outstretched hand. Sports, bike and car accidents, and falls from a height can cause them in younger people.
In older adults, osteoporosis (thinning bones) makes the wrist more likely to break from a simple fall from standing. A wrist fracture after a minor fall can be the first sign of osteoporosis and is a reason to consider a bone health check and a fall-risk assessment.
How We Diagnose It at POPB
Dr. Tucker will examine your wrist, check the nerves and blood flow in your hand, and look at the skin. X-rays are taken in our office during your visit to show where the bone is broken and whether the pieces have shifted.
Scaphoid fractures can be hard to see on early X-rays. If one is suspected, your wrist may be splinted and re-imaged, or you may have an MRI in our office. A CT scan may be ordered for complex fractures that extend into the joint.
Non-Surgical Treatment Options
Many wrist fractures heal without surgery when the bones are in good position or can be moved back into place:
- A splint at first while swelling settles, followed by a cast, usually for about 6 weeks for a distal radius fracture. Scaphoid fractures often need longer.
- Closed reduction, in which the physician gently realigns the bones without an incision, followed by a cast
- Repeat X-rays in our office over the first few weeks to make sure the bones stay in position
- Elevation, finger motion and ice to control swelling while you are in a cast
Surgical Options
Surgery may be recommended when the bones are badly shifted, broken into several pieces, extend into the joint, or slip after a cast. Dr. Tucker commonly uses a plate and screws placed through an incision to hold the bones in position while they heal. Pins or an external fixator (a frame outside the wrist) are used in some fractures. Displaced scaphoid fractures are often fixed with a single screw.
Most wrist fracture surgery is done on an outpatient basis at an area surgery center or hospital.
Recovery
Bone healing usually takes about 6 to 8 weeks for a distal radius fracture and can take several months for a scaphoid fracture. Stiffness is common once the cast or splint comes off, and most people regain much of their motion and strength over 3 to 6 months, with some improvement continuing up to a year. Timelines vary with age, bone quality and fracture type.
Hand therapy with Elise Burger, OTR, our occupational and hand therapist, often starts after the cast is removed or soon after surgery. She fits removable splints, works on motion, swelling and grip strength, and shares your chart with Dr. Tucker.
Insurance and Cost
Fracture care, X-rays, casting, hand therapy and medically necessary surgery are generally covered by Medicare, most commercial PPO plans and workers' compensation, subject to your deductible and co-pay. HMO and managed-care plans require a primary care referral in our office before the visit.
If you were injured at work, we coordinate treatment, return-to-work planning and workers' compensation documentation with your employer and carrier.
When to Be Seen
Go to the emergency room if your wrist is obviously deformed, your fingers are numb, cold or pale, or there is an open wound or bone showing. For a painful, swollen wrist after a fall without those signs, call our office for a prompt visit with X-rays on site.
Do not ignore wrist pain at the base of the thumb after a fall, even if it seems like a sprain. An untreated scaphoid fracture can fail to heal and lead to arthritis.
