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Cascade Orthopaedics Practice Newsletter
September 2014
Thanks for being a patient of Cascade Orthopaedics! While many patients visit us for a specific problem, they or their loved ones often have other unrelated orthopaedic concerns. We are producing a monthly newsletter with the intent to provide a source of information and to serve as an educational resource for our patients on some common problems, and give advice on maintaining musculoskeletal health. Our goal is to help you prevent problems, and recognize what conditions might be causing pain and disability. We may also suggest resources that might be available to help you prevent or manage problems.  Cascade's Website
 

WRIST FRACTURES

Figure 1

Fractures of the wrist are common orthopaedic injuries.  Occuring in young and old alike, these injuries can create a frustrating amount of pain and disability. Fortunately, most of these injuries can be recognized, and if treated early on, an excellent functional result is usually obtained.
 

CAUSES:  

 

Fractures of the wrist are a common result of falls and impacts to the wrist area.  The most common injuries are those that involve falls onto the outstretched hand forcing the wrist into an extended position (see Figure 1 above).  Also seen are wrist fractures that occur from vehicular  accidents (car, motorcycle, bicycle, etc.) or impact from a moving object (person, ball, door, etc.).


 

Wrist fractures can involve single or multiple bones around the wrist joint.  The anatomy of the wrist joint is complex and involves multiple bones (see Figure 2 below).  The major supporting bone of the wrist is the radius.  It is paired with the smaller ulna.  The two bones in conjunction provide rotation of the forearm.  The end part of the radius (distal radius) forms a sort of cup to support the group of smaller rounded bones of the wrist, the carpal bones. The carpal bones consist of 9 bones (scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate and hamate.) 

Figure 2


 

While any of these bones can suffer a fracture, the most commonly involved are the distal radius and the scaphoid. Therefore we will limit our discussion to these.

DISTAL RADIUS FRACTURE:


 
Fractures of the distal radius are by far the most common. They therefore have received the most attention. These fractures can be anything from simple to complex, and the treatment can be anything from immobilization in a cast to complex surgery. Treatment also differs by age group.

Children

In children a different set of rules apply. Children's bones are still growing and the distal radius has growth areas. These growth areas are a type of "seam" in the bone and can be a weak spot through which to break the bone. However, as the bones of a child are continuously growing, there is a great potential for a bone that is crooked to remodel or straighten with growth. This allows more leeway in tolerating an imperfect correction of alignment of the fracture. As a result, the fractures of the distal radius in children is usually managed by simple casting or correcting the alignment by manipulation (setting) of the distal radius and placing a splint or cast. On occasion, surgical pins are placed into the bone to add stability to particularly unstable fractures (see Figure 3 below). Luckily, the forgiving nature of the bones of a child afford a good result in most cases.
 

Figure 3

Adults 

Fractures of the distal radius in adults also vary in complexity. A fractured bone can be non-displaced or "hairline". In this case simple immobilization in a cast (see Figure 4 below) is often adequate treatment.
Figure 4
In the case where the fractured parts of the bones are shifted or separated (see Figure 5 below), the wrist is crooked as a result, and treatment is more complex.
Figure 5
The displaced bone fragments often need to be brought into alignment. This can be done in a couple of ways. One method is to externally manipulate them into position and place a cast. If this is not possible or successful, we often opt for a surgical approach.

Surgical treatment for adult fractures of the distal radius can very from simple to complex depending on the complexity of the fracture pattern (how many pieces is the bone broken into and the configuration of the breaks.) The good news is that in the last 15 years, there have been a lot of technological advances in treatments of these fractures, so orthopaedic surgeons have some very good tools (see Figure 6 below). The benefit of surgical treatment of the fracture is that alignment is often restored to normal, and prolonged cast immobilization can be avoided.
Figure 6

SCAPHOID FRACTURE:

While they occur infrequently in children, fractures of the scaphoid are most common in teens and adults. The scaphoid is a 1 inch long peanut shaped bone (see Figure 7 below) that is critical for normal wrist function. Unlike distal radius fractures, which heal quickly, the scaphoid bone is fussy and slow to heal. This is because of the limited circulation attachments of the bone.

When there is a hairline fracture, there are options for cast or surgical treatment. However, if the fracture is at all displaced, surgery is usually indicated to restore normal alignment of this critical little bone.
Figure 7
Once again, in recent decades, surgical implants and techniques have been developed which simplify and facilitate treatment of these tricky fractures.  Still, healing is slow and uncertain, so extreme vigilance is indicated.
Figure 8
In summary, fractures of the wrist are common and treatable.  Each is different and factors of age, fracture pattern, activity level, etc. can bear on treatment choices.  If you have persistent wrist pain after a fall, significant swelling or deformity, you are best to splint the wrist as best as possible or go to the ER / urgent care.  If possible, call and go directly to see the orthopaedist who will be definitively managing your care in most cases.
 
This material presented is for educational and informational purposes only. You should consult a physician or health care provider for actual evaluation, diagnosis, and individual treatment recommendations or advice. 


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