Both wrist sprains and fractures can be extremely painful. 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. In fact, the majority of wrist fractures occur outdoors during the winter months when snow and ice make walking hazardous, and falls are common. Wrist sprain and fractures are most commonly seen in young children and adults, especially women, over the age of 50.
If you suspect you have a wrist injury, seek medical attention to determine the nature of your injury and the appropriate course of treatment.
What’s the difference between a sprain and a fracture?
A wrist sprain refers to an injury to the ligaments which stabilize the bones of the wrist joint. Some are due to ligament tears, making the medical evaluation of this problem very important.
A wrist fracture refers to a break in one or more of the bones in the wrist which is comprised of 10 bones; 8 hand bones (carpals) and 2 forearm bones (radius and ulna). The most common fracture involves the radius (the largest bone in the wrist joint, extending up to the elbow). A common fracture that occurs in children is the Colle’s fracture of the wrist. In this case, the wrist will be “bent” upward.
Symptoms and Diagnosis
Common symptoms of wrist fractures and sprains are pain and swelling in the joint. Both injuries can cause pain when attempting joint motion, lifting, or grasping. A physician, such as Dr. Leah Urbanosky, will examine the injured wrist for tenderness to the touch, deformity, swelling, potential nerve injury, pink nail beds and movement in each finger. If a fracture is suspected, a physician will order an x-ray immediately.
There are a few ways to tell the difference between a sprain and a fracture before seeking medical help or before medical help arrives.
Symptoms of a sprain include:
• muscle or joint pain instead of bone pain (can be difficult to determine when pain is extreme)
• swelling or bruising
• wrist can move but it causes great discomfort to do so
• red and warm
Symptoms of a fracture include:
• hearing or feeling a “snap”
• swelling around the bone
• incredibly painful to the touch
• moving the wrist is almost impossible
• bone can penetrate through the skin
• persistent pain
• swelling near the wrist
• changes in finger movement
A simple fracture means that the bone has broken, but the broken edges remain close enough together. This usually means that simple manipulation to realign the bone and a cast is required
A 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.
Your physician will typically recommend these steps to treat a wrist sprain:
1. Compress the sprain with an Ace bandage. Keep the bandage tightly wrapped around the sprain for two days.
2. Apply an ice pack or a zip-close bag filled with ice to the sprain immediately. Continue to apply ice to the area as well.
3. Keep the injury raised above heart level to reduce swelling.
4. Make sure the injured person is resting. No activity should be done while the wrist is healing. Heavy activities, such as lifting, playing sports or exercising, can make the injury worse.
5. If no progress is made within one week, seek additional medical attention.
The primary goal of treatment is to return normal movement to the affected hand and wrist. You may also be given therapeutic exercises to preserve movement, flexibility and to build strength. The appropriate treatment depends on the location and severity of the fracture (simple or complex).
Typically, a physician will recommend a cast or splint extended above the elbow to restrict movement of both the elbow and wrist. Your physician 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 help prevent finger stiffness.
Over the first two to three weeks, your wrist will be x-rayed weekly. If the bones have slipped out of position, surgery may be needed to reposition the bones and pin them in place. Usually, the cast or splint is removed after six to eight weeks.
After the cast or splint is removed, you may occasionally use a wrist support or splint to support and protect the joint.
Close orthopaedic follow-up is necessary in all cases of wrist fracture to be certain of recovery. Joint stiffness and muscle weakness, after long immobilization in a cast, can be reversed with appropriate physical therapy and exercise.
If you would like a consultation about your hand or wrist injury, please call Dr. Leah Urbanosky at: (815) 462-3474.
The scaphoid is one of the smallest bones in the wrist. It is on the thumb side of the wrist where the wrist bends.
This type of fracture, or break in the bone, occurs most frequently when a patient falls and attempts to break the fall using his/her hands. Scaphoid fractures (also called navicular fractures) can also be a result of sporting collisions or motor vehicle accidents. The use of wrist guards during some activities like skating and boarding is a way to prevent this fracture from occurring.
Because falls are common, this type of fracture is not limited to a specific gender or age group, though men from 20 to 30 years of age are most likely to experience this injury.
Symptoms and Diagnosis
Usually, there are obvious physical symptoms of scaphoid fracture, including:
• Major pain when moving the wrist or thumb
• Minor physical deformity
• Swelling in the wrist area and at the base of the thumb
• Inability to grip objects
The physical signs of a fracture are usually the reasons that bring a patient into a physician’s office. However, a physical exam isn’t thorough enough to diagnose a fracture–especially a scaphoid fracture–because they are frequently misinterpreted as sprains.
A hand and wrist specialist, such as Dr. Leah Urbanosky of Hinsdale Orthopaedics, will order an x-ray in order to determine the location and severity of the break. Sometimes, a scaphoid fracture may not show up on an x-ray until a few weeks after the initial pain. In this case, Dr. Urbanosky would suggest the use of a splint until the x-ray can be retaken and reevaluated.
Once a physician has diagnosed a scaphoid fracture, there are several ways to treat the condition, both surgically and non-surgically.
Scaphoid fractures near the thumb heal the most quickly because this portion of the bone receives the most blood supply. A doctor will typically order an arm and hand cast to set the bone properly. If the fracture is near the forearm, however, this cast will include the arm, hand, and the thumb. It may also cover the elbow.
If a cast does not fully heal the scaphoid fracture, a physician may recommend surgery to fix the break. The procedure is based upon the location of the fracture and how severe it is. Typically, metal implants are used to hold the scaphoid in place until the bone heals.
Whether surgery is necessary or not, a cast is needed in order to allow the bone to heal. During recovery, lifting, contact sports, and climbing are all highly discouraged. Physical therapy is often required. Most cases return to normal within six months of care.
Non-union Scaphoid Fractures
A fracture that fails to heal properly is called a non-union. Since the blood supply to the area is poor, this is fairly common with scaphoids. If the fracture cannot heal on its own, a bone graft may be applied. A bone graft includes the transfer of a piece of bone from elsewhere in the body into the scaphoid to promote healing.
If you think that you may be experiencing a wrist fracture or sprain, contact Dr. Leah Urbanosky for a consultation: (815) 462-3474.