A broken wrist, formally known as a distal radius fracture, is one of the most common bone injuries, typically resulting from a fall onto an outstretched hand. This fracture occurs in the radius, the larger of the two forearm bones, near the wrist joint. The decision between non-surgical treatment and surgical intervention depends on a detailed assessment of the injury. Surgery is determined by the fracture’s severity, pattern, and the degree to which the bone fragments have shifted. The choice of treatment aims to restore the wrist’s anatomy to ensure long-term function and minimize complications.
Understanding Fracture Classification
Orthopedic surgeons rely on specific characteristics to classify a distal radius fracture, which guides the treatment plan. A primary distinction is made between displaced fractures, where bone fragments shift out of alignment, and non-displaced fractures, which maintain acceptable alignment and are often treated without an operation.
The stability of the fracture is another important factor, determining whether the bone fragments are likely to move after initial treatment. Fractures are also classified by whether the break extends into the joint surface (intra-articular) or remains outside the joint (extra-articular). Intra-articular fractures are often more complex and require precise realignment to prevent the development of post-traumatic arthritis.
Fracture patterns are further categorized by the direction of the break, such as the common Colles’ fracture. Classification systems, like the AO/OTA system, describe the fracture’s complexity, including comminution, which is when the bone is broken into multiple small pieces. These detailed classifications help predict how the fracture will behave and whether it will remain stable.
Indicators That Require Surgical Intervention
Surgery, often performed as Open Reduction Internal Fixation (ORIF), becomes necessary when non-operative methods will not achieve an acceptable long-term outcome. One of the clearest indications for surgery is an unstable fracture that cannot be held in a proper position by a cast alone. This instability often occurs when the bone is severely comminuted or shattered, making simple immobilization inadequate to maintain alignment.
Specific measurements from X-rays also mandate surgical intervention. These include fracture displacement greater than 2 millimeters, excessive dorsal angulation (backward tilt) exceeding 20 degrees, or significant radial shortening of more than 3 millimeters. ORIF restores the bone’s anatomical alignment and stability using internal hardware like metal plates, screws, or pins.
Fractures that involve the wrist joint surface, especially with a “step-off” or gap of 2 millimeters or more, frequently require surgery to recreate a smooth joint surface and reduce the risk of future arthritis. Open fractures, where the bone pierces the skin, also require immediate surgical attention to clean the wound and stabilize the bone. In some cases, external fixation, where a frame is placed outside the wrist, is used to hold severely unstable fragments in place while soft tissues heal.
Non-Surgical Treatment Alternatives
For fractures that are stable or minimally displaced, non-surgical management is the preferred course of action. This treatment begins with a closed reduction, where the surgeon manually manipulates the bone fragments back into an acceptable position without making an incision. This procedure is typically performed under local anesthesia and sometimes with sedation.
Following the reduction, the wrist is immobilized, initially with a splint to accommodate swelling, and then transitioned to a fiberglass cast within a few days. The cast holds the bone fragments in the corrected position, preventing displacement while the bone heals. Immobilization typically lasts for about six weeks, allowing the initial bony union to occur.
Follow-up X-rays are taken periodically to ensure the fracture remains aligned. If the bone fragments shift and the position becomes unacceptable, the surgeon may attempt a repeat closed reduction or suggest a surgical procedure. For some unstable fractures, small Kirschner wires may be temporarily inserted through the skin to hold the fragments in place alongside the cast, a technique called percutaneous pinning.
Recovery and Rehabilitation Timeline
Once the cast is removed or the surgical fixation is deemed stable, physical therapy becomes a focus to address the stiffness that develops during immobilization. Most patients begin gentle wrist range-of-motion exercises within one to two weeks following surgery or immediately after cast removal.
The bone typically achieves sufficient strength to begin light active use of the hand around six weeks after the injury or surgery. Regaining full strength and range of motion takes considerably longer, with functional recovery often spanning three to six months. Patients are advised to avoid heavy lifting or high-impact activities for up to three months to protect the healing bone.
Functional recovery, including the return to daily activities like driving and light lifting, usually occurs between eight and twelve weeks. This timeline varies significantly depending on the fracture’s complexity and the patient’s age. While the bone is mostly healed within three months, some residual stiffness and minor pain can persist. Full recovery, including final improvements in grip strength, may continue for up to one year. Consistency with the prescribed rehabilitation program is important for achieving the best possible long-term function.