Wrist Fractures (Carpal Bones, Radius, and Ulna)

What are wrist fractures?

Wrist fractures occur when there is a break or crack in one of the many bones located within the wrist or hand.

Symptoms

Symptoms include:

• severe pain that worsens when the area is pressed
• swelling
• bruising
• deformity (such as a bent wrist or crooked finger)
• stiffness or inability to move the fingers or just the thumb
• numbness in the hand

Causes and Risk Factors

Direct blows or crushing injuries to the hands and wrists can break bones in the area. The most common causes and risk factors include:

• falls (when a person tries to break the fall with an outstretched hand)
• sports injuries, especially in high-impact activities like basketball, football, rugby, wrestling, hockey, skiing, snowboarding, and skateboarding
• high-speed motor vehicle collisions (can break wrist and hand bones in multiple places, often requiring surgical repair)

Complications from wrist trauma are rare but may include:

• stiffness, pain, or disability: usually subside one or two months after the cast is removed or after surgery, and may continue to improve for up to two years. However, if the injury is severe, permanent stiffness or pain may occur
• osteoarthritis: fractures that extend into the joint can cause arthritis years later. If the wrist or hand begins to hurt or swell long after the injury, consult a doctor for evaluation
• damage to blood vessels: trauma to the wrist or hand can affect nearby nerves and blood vessels. Seek immediate attention if you notice numbness or circulation problems

Diagnosis

Usually involves a physical exam and imaging tests, including:

• X-ray: a good tool for visualizing bone. It’s painless and takes only a few minutes
• CT scan: reveals fractures that X-rays may miss and shows injuries to soft tissues and blood vessels
• MRI: uses radio waves and a powerful magnet to produce detailed images of bones and soft tissues. It’s much more sensitive than X-rays and can detect small fractures and ligament injuries

Treatment

If the broken bone ends are not properly aligned, the doctor will need to reposition them—a process called fracture reduction. Depending on the level of pain and swelling, the patient may receive a muscle relaxant, sedative, or even general anesthesia before the procedure.

Treatment options include:

• immobilization: restricts movement of the broken bone and is essential for proper healing. Splints are commonly used
• medications: to relieve pain, the doctor may recommend over-the-counter pain relievers like acetaminophen. For severe pain, opioids such as codeine may be prescribed
• therapy: after conservative treatment and cast removal, most patients need rehabilitation exercises or physical therapy to reduce stiffness and restore wrist and hand movement. Recovery may take several months for severe injuries
• surgical procedures: if immobilization is not an option, surgery may be required. Internal fixation devices such as plates, pins, screws, or bone grafts are used to maintain proper bone alignment during healing

These devices may be necessary in cases of:

• multiple fractures
• unstable or displaced fractures
• loose bone fragments that could enter a joint
• damage to surrounding ligaments
• fractures extending into the joint
• crush injuries

In some cases, the surgeon may use an external fixation device to stabilize the fracture.

Prevention and Recommendations

It’s impossible to avoid all accidents that may cause a broken wrist or hand. However, some basic tips can help with protection:

• build strong bones! Maintain a nutritious diet with calcium and vitamin D
• engage in physical activity
• avoid or quit smoking
• prevent falls by wearing proper footwear, removing household hazards, improving lighting, and avoiding slippery surfaces
• in some cases, check your vision, install grab bars in the bathroom, and handrails on stairs
• when engaging in high-risk activities, don’t forget wrist guards
• for patients in recovery: be patient! Talk to your doctor about helpful exercises or request a referral for physical or occupational therapy

An important recommendation is to seek a specialist if trauma is suspected. It’s crucial to treat a broken wrist or hand as soon as possible—otherwise, bones may heal misaligned, affecting daily activities, range of motion, and hand strength.

By Einstein Editorial Board