So You Broke Your Wrist — Now What?
⌚️ read time: 4 minutes
Welcome back.
Today, I want to talk about wrist fractures. Specifically, the most common type of wrist fracture, known as a distal radius fracture.
The wrist is made up of eight tiny little bones plus the ‘distal’ end of your two forearm bones known as the radius and ulna (distal means further away from the center of your body). While any of these bones can break, the ‘distal’ end of your radius is the most frequently fractured bone after an impact on your hand or wrist.
What is a distal radius fracture?
While the radius is actually a forearm bone (see Figure 1), it commonly breaks near the junction between the forearm and wrist. We call this the ‘distal’ end of the bone (opposite of ‘proximal,’ which is near your elbow) — which is where the term distal radius fracture comes from.
Below you will see both front and side-view x-rays of a normal wrist in the first image, followed by x-rays of a distal radius fracture in the second. Can you spot the break?
Did you see the fracture?
Here it is outlined in yellow if you didn’t catch it.
Will my wrist fracture heal in a cast?
Let’s focus on two key concepts: displacement and angulation.
Displacement refers to how far the broken bone ends have moved apart. Angulation refers to how far out of alignment they are. Understanding these two factors is crucial for analyzing wrist x-rays and determining the treatment that is most likely to succeed.
Why do displacement and angulation matter? If your bones are too displaced, they may not heal properly on their own or in a cast. If they’re too angled, they might heal crooked, leading to deformity, loss of movement, weakness, or arthritis.
On the contrary, a bone that has broken without significant displacement or angulation may heal just fine with a few weeks in a cast.
It really all is in the details of the fracture pattern.
Which distal radius fractures benefit from surgery?
Let’s use the example fracture we saw earlier. I’ve outlined both the displacement and angulation in the figure below.
Notice the broken bones have displaced enough to dramatically shrink the angle between the red lines and move the corner of the distal radius far below the corner of the distal ulna (green arrow).
And on the side view?
Look at the joint outlined in yellow — it’s tipped 45 degrees backwards! Angulation, angulation, angulation…
And as I mentioned above, displacement and angulation can lead to crooked bone healing, weakness, stiffness, arthritis…
Suffice it to say that if your x-rays look like those above, you will want to consider surgery to restore your normal anatomy as best as possible.
How is a distal radius fracture fixed surgically?
I go into greater detail in my in-depth article here, but the basic answer is…with a plate and screws.
This is called ‘open reduction internal fixation’ or ORIF in the orthopedic world.
Translation: Open the skin (surgery). Reduce the fracture (put it back in alignment). And place something Internally (plate and screws) to Fix it in place. ORIF!
Below is an x-ray of a distal radius fracture that has now been fixed with a plate and screws.
And below that, I have re-drawn the same displacement and angulation lines you will remember from our earlier x-rays.
Notice how with surgery, I have increased the angle between the red lines back to normal, restored the relationship between the corner of the radius and the corner of the ulna (green line), and put that darn joint back up on top where it belongs (yellow).
The anatomy is restored. This stuff is just too cool.
Takeaways:
Most of the time, the term ‘wrist fracture’ refers to breaking the end of the forearm bone known as the radius, at the point just where it meets the wrist bones.
Not all wrist fractures are created equal. Whether one would benefit from casting or surgery depends on the displacement and angulation of the broken bone ends.
When they do need surgery, the goal of the procedure is to restore the normal anatomy as best as possible — typically by using plates and screws.
So there you have it.
Now you know a little more about wrist fractures, why we fix them, and how we fix them with surgery.
While I hope you never experience any of the above, tuck this one away in case you or someone you know becomes one of the 15% who suffer this injury at some point in their life…
