A fractured wrist is a common injury, typically resulting from a fall onto an outstretched hand, where the force travels up the arm to break one or more of the 10 bones that make up the wrist and forearm. Most frequently, this injury involves the distal radius, the larger of the two forearm bones near the thumb side of the wrist. While this article describes the observable signs of a fracture, a self-assessment is never a substitute for a professional medical diagnosis, which is necessary to determine the specific nature and severity of the break.
Visual Appearance and Accompanying Sensations
The most immediate sign of a wrist fracture is intense, sharp pain that is distinctly more severe than a sprain and worsens significantly with any attempt to grip or move the hand. This persistent pain is coupled with a rapid onset of localized swelling as blood vessels are damaged and fluid accumulates. Bruising or discoloration will often appear within minutes or hours as blood spreads beneath the skin from the internal trauma.
A significant indicator of a more severe fracture is a visible deformity where the wrist appears bent, crooked, or angled unnaturally. In certain displaced fractures, such as a Colles’ fracture, the wrist can take on a characteristic “dinner fork” appearance. This occurs when the forearm bone shifts and creates a distinct hump on the back of the wrist. This misalignment happens when the force of the impact is strong enough to move the broken bone fragments out of their normal anatomical position.
Accompanying these visual signs are specific sensory changes that can point toward nerve involvement. The median nerve, which passes through the wrist, can become irritated or compressed by the trauma or subsequent swelling. This pressure manifests as numbness, tingling, or a “pins and needles” sensation, particularly in the thumb and first two fingers. An inability to move the fingers or a significant reduction in the range of motion are also indicators of a bone fracture.
Immediate Care and Stabilization
Once a fracture is suspected, the immediate focus should be on stabilizing the injury and managing pain until medical help is reached. The R.I.C.E. protocol—Rest, Ice, Compression, and Elevation—provides a framework for initial care. Resting the limb gently prevents movement of the broken fragments. Elevation is effective, as keeping the hand and wrist above the level of the heart uses gravity to reduce blood flow, minimizing swelling and pain.
Applying a cold pack or ice wrapped in a thin towel for 20 to 30 minutes can help numb the pain and decrease inflammation. For gentle immobilization, a temporary splint can be created using rigid, well-padded household materials, such as a rolled-up newspaper or a sturdy magazine. The splint should extend from the middle of the forearm to the fingertips, securing the wrist and the joints above and below the fracture. Ensure the wrapping is not so tight that it restricts circulation.
Never attempt to “set” or manipulate the injured wrist back into an anatomical position, as this can cause further soft tissue or nerve damage. For initial pain relief, over-the-counter acetaminophen is often recommended as the first choice. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can potentially interfere with the early stages of bone healing. It is important to check for acetaminophen in any other combination medications being taken.
Red Flags and Professional Assessment
Certain symptoms following a wrist injury are considered red flags that necessitate immediate emergency medical attention. An open or compound fracture occurs when bone fragments break through the skin, carrying a severe risk of deep infection. Signs of neurovascular compromise, where blood flow or nerve function is severely affected, are also an emergency.
Neurovascular compromise may include the fingers becoming pale, blue, or cold to the touch, indicating poor circulation, or the presence of complete numbness or paralysis. Acute compartment syndrome is a dangerous condition that occurs when swelling causes excessive pressure within the muscle compartments of the forearm or hand. The hallmark sign is pain that is disproportionately severe compared to the visible injury and worsens significantly when the fingers are passively stretched.
Diagnostic Imaging
The diagnostic process begins with a physical examination, where a doctor assesses the wrist for tenderness, swelling, and any nerve or circulation issues. To confirm a fracture, X-rays are the standard tool, providing two-dimensional images that visualize the bone fragments and their alignment.
If the fracture is complex, extends into the joint, or involves smaller bones like the scaphoid, the doctor may order a Computed Tomography (CT) scan. A CT scan provides a detailed, three-dimensional view of the bone structure. Magnetic Resonance Imaging (MRI) is used to assess associated soft tissue injuries, such as damage to ligaments or tendons.