Summary

A wrist fracture is a break in one or more bones of the wrist, most commonly the distal radius (the end of the forearm bone near the wrist). Think of your wrist as a complex joint made up of multiple small bones—when you fall on an outstretched hand, the force can break these bones, especially the radius. Wrist fractures are very common, especially in older adults (osteoporosis) and young adults (sports, falls). The most common type is a Colles fracture (distal radius fracture with backward displacement), but there are many types depending on which bone breaks and how it breaks. The severity ranges from simple cracks (non-displaced) to complex breaks with multiple fragments (comminuted). The key to management is recognizing the fracture (clinical examination, X-ray), assessing for complications (nerve injury, compartment syndrome), reducing the fracture if displaced (manipulation under anesthesia), immobilizing it (cast or splint), and monitoring for complications. Most wrist fractures heal well with proper treatment, but some may need surgery if complex or unstable.

Key Facts

• Definition: Fracture of one or more bones of the wrist (usually distal radius)
• Incidence: Very common (most common fracture in adults)
• Mortality: Very low (<0.1%) unless complications
• Peak age: Bimodal (young adults from trauma, older adults from osteoporosis)
• Critical feature: Pain, swelling, deformity at wrist after fall
• Key investigation: Clinical examination, X-ray
• First-line treatment: Reduction if displaced, immobilization (cast/splint)

Clinical Pearls

"FOOSH is the classic mechanism" — Fall On Outstretched Hand (FOOSH) is the classic mechanism. Always ask about falls.

"Check for nerve injury" — Median nerve injury (carpal tunnel syndrome) can occur with distal radius fractures. Check sensation in thumb/index finger.

"Scaphoid fractures can be missed" — Scaphoid fractures may not show on initial X-ray. If clinical suspicion (tenderness in anatomical snuffbox), treat as fracture and repeat X-ray in 2 weeks.

"Age affects treatment" — Older adults (osteoporosis) may need different treatment than young adults. Consider bone quality when planning treatment.

Why This Matters Clinically

Wrist fractures are very common and usually heal well with proper treatment. Early recognition, appropriate reduction and immobilization, and monitoring for complications are essential to ensure good outcomes. This is a condition that emergency and orthopedic clinicians see frequently and can manage effectively.

Structured Approach: ABCDE

A - Airway

• Assessment: Usually patent
• Action: Secure if compromised

B - Breathing

• Look: Usually normal
• Listen: Usually normal
• Measure: SpO2 (usually normal)
• Action: Support if needed

C - Circulation

• Look: Usually normal
• Feel: Pulse (check radial pulse), BP (usually normal)
• Listen: Heart sounds (usually normal)
• Measure: BP (usually normal), HR
• Action: Monitor if severe

D - Disability

• Assessment: Usually normal
• Action: Assess if other injuries

E - Exposure

• Look: Wrist examination
• Feel: Tenderness, deformity
• Action: Complete examination

Specific Examination Findings

Wrist Examination:

• Inspection: Deformity, swelling, bruising
• Palpation:
  • Tenderness: At fracture site
  • Deformity: Obvious if displaced
  • Crepitus: May feel grinding (don't try to elicit)
• Range of motion: Limited due to pain
• Neurovascular: Check pulses, sensation, movement

Special Tests:

Special Tests

Natural History (Without Treatment)

Untreated Wrist Fracture:

• May heal: But in wrong position (malunion)
• Functional loss: Stiffness, weakness
• Pain: May have persistent pain

Outcomes with Treatment

Factors Affecting Outcomes:

Good Prognosis:

• Early treatment: Better outcomes
• Proper reduction: Better outcomes
• Stable fractures: Usually heal well
• Young age: Better healing

Poor Prognosis:

• Unstable fractures: May need surgery
• Intra-articular: May affect joint function
• Complications: Nerve injury, malunion worsen outcomes
• Older age: May heal slower

Prognostic Factors

Key Guidelines

1. BOA Guidelines (2016) — Management of distal radius fractures. British Orthopaedic Association

Key Recommendations:

• X-ray for diagnosis
• Reduction if displaced
• Immobilization
• Evidence Level: 1A

Landmark Trials

Multiple studies on treatment options, outcomes.

Evidence Strength

What is a Wrist Fracture?

A wrist fracture is a broken bone in your wrist, most commonly the end of your forearm bone (radius) near your wrist. Think of your wrist as a complex joint—when you fall on an outstretched hand, the force can break these bones, causing pain, swelling, and sometimes an obvious deformity.

In simple terms: Your wrist bone is broken, usually from falling on your hand. With proper treatment, most people recover well and regain full function.

Why does it matter?

Wrist fractures are common and usually heal well with proper treatment. Early recognition, appropriate reduction (if the bones have moved), and immobilization (cast or splint) are essential to ensure good outcomes. The good news? With proper treatment, most people recover completely and regain full function.

Think of it like this: It's like breaking a bone in your wrist—with the right care, it usually heals well and you get back to normal.

How is it treated?

1. Assessment:

• X-ray: You'll have an X-ray to see the fracture
• Examination: Your doctor will check for complications (nerve injury, etc.)

2. Reduction (If Bones Have Moved):

• What: Your doctor will move the bones back into place (you'll get pain relief/anesthesia)
• Why: To ensure the bone heals in the right position
• When: Usually done soon after the injury

3. Immobilization:

• Cast or splint: Your wrist will be put in a cast or splint to keep it still while it heals
• Duration: Usually 4-6 weeks (longer for some fractures like scaphoid)
• Why: To allow the bone to heal properly

4. Follow-Up:

• X-rays: You'll have X-rays to check the bone is healing
• Remove cast: When the bone is healed, the cast will be removed
• Rehabilitation: You'll do exercises to regain movement and strength

5. Surgery (If Needed):

• When: If the fracture is unstable or complex
• What: Metal plates and screws to hold the bones together
• Why: To ensure proper healing

The goal: Help the bone heal in the right position and regain full function.

What to expect

Recovery:

• Initial: Pain and swelling (will improve)
• Cast: You'll wear a cast for 4-6 weeks (or longer)
• Healing: The bone usually heals within 6-12 weeks
• Full recovery: Most people regain full function within months

After Treatment:

• Pain: Should improve within days to weeks
• Swelling: Should improve within days to weeks
• Movement: Will be limited while in cast, improves after removal
• Follow-up: Regular follow-up to monitor healing

Recovery Time:

• Bone healing: Usually 6-12 weeks
• Full function: Usually 3-6 months
• Some stiffness: May persist for months (improves with exercises)

When to seek help

See your doctor if:

• You have wrist pain after a fall
• You have obvious deformity or swelling
• You can't use your hand properly
• You have concerns about your wrist

Call 999 (or your emergency number) immediately if:

• You have an open fracture (bone visible through skin)
• Your hand becomes pale, cold, or numb
• You have severe pain that's getting worse
• You feel very unwell

After treatment, see your doctor if:

• Your pain gets worse
• Your hand becomes numb or weak
• Your cast becomes too tight or loose
• You have concerns about your recovery

Remember: If you fall and hurt your wrist, especially if you have obvious deformity or can't use your hand, see your doctor. Most wrist fractures heal well with proper treatment, but some need urgent attention.