Learning Objectives     1. Define wrist fracture and its incidence in men and women.     2. Define simple and complex fractures.     3. Describe the treatment and rehabilitation process for a wrist fracture.     4. Describe 4 measures that can be taken to prevent future fractures.

Mrs. M., 61 years old, slipped on the ice this winter. When she tried to break her fall, she landed on her outstretched hand and broke her wrist.

Definition

Wrist fracture is the most common type of fracture before the age of 75. In women, the number of wrist fractures increases at menopause and plateaus after age 65. This increased incidence is most likely related to the rapid loss of bone in the years following menopause. Since men do not experience menopause, the incidence of wrist fracture in men remains fairly constant. Wrist fracture occurs most often in women who are relatively healthy and active and have good reflexes. In fact, the majority of wrist fractures occur outdoors during the winter months when snow and ice make walking treacherous, and falls are common.

The wrist is made up of two bones, the radius and ulna, and the small bones of the hand. The most common wrist fracture occurs when a person extends an arm to break a fall. The hand and forearm take all the weight and force from the fall, and one of the wrist bones breaks. When the radius breaks within one or two inches of the wrist (the distal radius), the fracture is called a Colles fracture, named after the doctor who first described it. Colles fractures occur most frequently in postmenopausal women. The risk for Colles fracture appears to be related to the bone density of the distal radius. A wrist fracture can be a sign of underlying problems such as low bone density, balance problems, vision problems, or hearing loss.

Diagnosis

Following a fall, you may be bruised and sore. Sometimes, a fracture may be misdiagnosed as a bad sprain, and the pain, limited movement, and weak hand grasp in the affected arm are ignored. If you have persistent pain, swelling near the wrist, changes in finger movement, or numbness, your wrist is probably fractured rather than sprained. Usually, an x-ray can confirm the diagnosis. Once the fracture is diagnosed, appropriate treatment begins.

Treatment and Rehabilitation

The primary goal of treatment and rehabilitation is to return normal movement to the affected hand and wrist. Throughout the healing process there will be exercises that you must do to preserve movement and flexibility, and build strength.

The appropriate treatment depends on the location and severity of the fracture. A simple fracture means that the bone has broken, but the broken edges remain close enough together that simple manipulation realigns the involved bone (known as reduction of the fracture). A more complex fracture means that multiple pieces of bone are broken or that the joint is involved. In this case, a cast alone may be inadequate and surgery may be required.

The first cast or splint will extend above the elbow to restrict movement of both the elbow and wrist. Your health care provider will teach you exercises for your fingers and shoulder on the affected side. It is important that you perform these exercises for short periods of time several times a day, even while in the cast. This will prevent finger stiffness later on, one of the side effects of the Colles fracture.

Over the first two to three weeks, your wrist will be x-rayed weekly. If the bones have slipped out of position, an operation may be needed to reposition the bones and pin them in place. In any case, the cast or splint is removed after six or eight weeks. Both active and passive exercises for the hand, wrist, forearm, elbow and shoulder will help you regain your strength and maintain mobility. After the cast or splint is removed, you may occasionally use a wrist splint or elastic wrap to support and protect the joint. Sometimes, the wrist may not look exactly the same as it did before the fracture, but with proper physical therapy, little function will be lost.

Initially, you will need assistance with your daily routine. If the break is in your dominant arm, you may need help with the easiest tasks: getting dressed, combing your hair, even brushing your teeth. Very independent people will find this a frustrating experience, but it helps to focus on the fact that wrist fractures heal and exercises strengthen the arm quickly. Before you know it, you will be back to normal.

The secondary goal of treatment is to determine whether osteoporosis is present.

Since wrist fractures occurring in women ages 40 60 can be the result of osteoporosis or may be an early warning sign of it, a bone density test would be appropriate at this time. A bone density test measures your current bone health and is the only way to predict your risk for future fractures.

Prevention of Future Fractures

If osteoporosis is present, or the risk of your developoing it is high, appropriate steps must be taken to maintain existing bone density is in the normal range, you should focus on preserving your bone health. Studies have shown that an adequate calcium and vitamin D intake and weight-bearing exercise preserve bone density. If the test shows that your bone density is low, calcium, vitamin D, and exercise may not be enough to protect against osteoporosis. Your doctor may prescribe a medication to prevent or slow further bone loss.

If you have not had a vision and hearing test in some time, this would be a good time to do so. Corrected vision and the best hearing possible can help prevent falls.

Source: National Osteoporosis Foundation

Reprinted with permission