Fractures of the wrist are very common. They are more common as we age and as the bone becomes weaker. Younger patients who get wrist fractures may have better bone but just require more force to break the bone.
In weaker bone, a simple fall may result in a wrist fracture often called a Colle’s fracture or Smith’s fracture depending on the position of the displaced fracture fragments. Below is an animation of how some of these fractures may be repaired. I have performed may of these operations usually with outstanding results. The biggest problem we can encounter is postoperative stiffness that we try to minimize with early physical therapy.
With good bone quality and a relative stable fracture repair, patients wear a splint for approximately 2 weeks after surgery. With soft bone or a severely fragmented fracture, splinting after surgery may be as long as 3-4 weeks. Some patients will require 6 weeks of postoperative splinting. A recent study has demonstrated that outcomes and results are similar regardless of the period of postoperative immobilization. It is really determined by the severity of the fracture.
Sometimes we treat patients with bilateral wrist fractures. Most of these patients will do much better if treated surgically so they can get out of their cast and become functional much earlier than if they were treated in casts alone.
The surgery usually takes between 45 – 60 minutes depending on the severity of the fracture and the degree to which the joint surface is involved in the fracture. Fractures extending into the joint are more difficult to fix. These are also easier to fix within the first 2 -3 weeks but can be done after that if there are extenuating circumstances. It is an out patient procedure.
Without surgery, these fractures are usually treated in a cast above the elbow for 3 weeks followed by a short arm cast for the next 3 weeks before therapy is started. Fractures that healed in an unacceptable / displaced position often result in stiffness, pain, deformity, reduced motion and arthritis.
While patients are rightfully concerned about the risks of surgery, there are certainly risks to nonsurgical treatment of some conditions.
Enjoy the clip…
JTM, MD