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Broken Wrist/Broken Hand

Definition


Disease: Broken Wrist/Broken Hand Broken Wrist/Broken Hand
Category: Bones, joints, muscles diseases
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Disease Definition:

It’s important to treat a broken wrist or broken hand as soon as possible because the bones may not heal in proper alignment, affecting the person's ability to perform everyday activities, such as grasping a pen or buttoning a shirt. So, someone should seek prompt medical attention in case they think they've sustained a broken wrist or a broken hand.

Depending on the exact site and severity of the injury, treatments for a broken wrist or a broken hand could vary. In the case of a complicated broken wrist or hand, in order to maintain proper alignment during healing, it may require surgery to realign the broken bone and to implant wires, rods, screws or plates into the broken bone.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

Some of the signs and symptoms that a person may experience in case of a broken wrist or broken hand include:

 

  • Tenderness
  • Swelling
  • Bruising
  • Numbness or coldness in the finger or thumb
  • Stiffness or inability to move the finger or thumb
  • Severe pain, which could increase during gripping or squeezing
  • A bent wrist, crooked finger, or other obvious deformities.

Causes:

“Broken wrist” and “broken hand” are terms that describe a range of fractures in this area of the body.

BROKEN HAND:
Each finger consists of one hand bone (metacarpal) and three finger bones (phalanges), and each of the thumbs consists of one metacarpal bone and two phalanges. A direct blow, a crushing injury or a fall can cause any of these bones to break.
Some of the common injuries during sports activities are hand bone injuries, and the names of these injuries are proof, for instance the “boxer’s fracture” is a punching injury that affects the metacarpal bone that leads to the little finger. There’s also the “baseball finger” and the “skier’s thumb”.

BROKEN WRIST:
Eight small hand bones make up the wrist in addition to two bones in the forearm, which are the radius, located on the thumb side of the arm, and the ulna, which is located on the pinky side of the arm. Together, these bones allow the wrist to straighten, rotate and bend, making a person capable of pitching a ball, swinging a jump-rope and banging a hammer.
Although any of these bones that make up the wrist can break, the most commonly broken bone is the radius. When a person falls forward onto an outstretched hand during a bike or ski accident, a car collision or when they fall from a roof or ladder, this type of fracture occurs, which is also called Colles’ fracture or a distal radius fracture.
Fractures of the ulna bone also are common and occur from a direct blow to your arm.
The carpal bone that is located near the base of the thumb, called scaphoid bone, is the most commonly injured carpal bone, which usually happens during a fall, however, it can also result from a blunt blow to the wrist.
 

Complications

Complications:

Although rare, some of the complications of a broken wrist or hand include:

Osteoarthritis:
In case a person's wrist or hand starts to hurt or swell after a long break, they should see a doctor for evaluation. Fractures that extend into the joint can cause arthritis years later.

Osteomyelitis (Bone Infection):
A bone may be exposed to bacteria and fungi that can cause infection in case someone's fracture is open.

Compartment Syndrome:
Pain, swelling and sometimes even disability is caused by this neuromuscular condition in the affected muscles of the legs or arms. This syndrome usually occurs in high-impact injuries, including motorcycle or car accidents.

Ongoing Stiffness, Aching or Disability:
After the broken bone has healed, the person may experience ongoing stiffness, pain or aching in the affected area, which usually goes away in a month or two after the cast is taken off or after surgery. In case a person's injury is severe, they may experience permanent stiffness or aching. It may take a few months before a person regains his/her ability to use their hand and fingers normally. A person should talk to the doctor about hand exercises that can help and they should also be patient with their recovery.

Nerve or Blood Vessel Damage:
Someone should seek immediate medical attention in case they notice any numbness or circulation problems, because in some cases, trauma to the wrist or hand can injure adjacent nerves and blood vessels.

Poor Healing:
Because of poor supply to the affected area of the body, scaphoid fractures or other hand or wrist fractures might be tougher to heal. Yet another risk factor for poor healing of fractures is smoking cigarettes. If the person is a smoker, he/she should consider quitting in order to give themselves the best chance of healing.
 

Treatments:

Usually, in an emergency room or urgent-care clinic is where initial treatment for a broken wrist or broken hand begins. In this case, the arm is typically evaluated and immobilized with a splint. In case a person has a displaced fracture, a procedure called reduction could be performed, which is when the pieces are manipulated back into their proper positions before applying a splint. A muscle relaxant, a sedative or even a general anesthetic may be needed before this procedure, depending on the amount of pain and swelling the person has.
If the person has a closed fracture, he/she will probably be sent home with the splint and directions to rest and ice the injury until he/she sees an orthopedic for further treatment in a few days.
A person may also be admitted to the hospital for additional treatment in case the fracture is more serious.

Treatment for a broken arm depends on:

 

  • The site of the injury
  • The severity of the injury
  • The age of the patient
  • The overall health of the patient


Some of the common methods of treatment are:

IMMOBILIZATION:
In order to heal properly, the movement of the broken bone in the hand should be restricted by using splints, braces or casts for three to eight weeks, depending on the injury. To make sure that the bones stay aligned, the doctor may request regular X-rays throughout the healing process.

SURGERY:
Immobilization can heal most broken bones. In some cases, some fractures require stabilization, so a person may need surgery in order to implant internal fixation devices, including screws, nails, wires or plates to maintain proper position of the bones during healing. surgery will be necessary in case someone has:

 

  • A fracture that is the result of a crushing accident
  • Loose bone fragments that could enter a joint
  • Fractures that extend into a joint
  • An unstable or displaced fracture
  • Multiple fractures
  • Damage to the surrounding ligaments
  • Open skin related to fracture.

 

Although some internal fixation materials can be removed after the bone heals, others are made of materials that are absorbed into the body, but mostly, these materials are left in place permanently. Some of the complications include lack of bone healing, wound-healing difficulties and infection, but they are rare.
The palm-side (volar) approach to surgery for distal radius fractures is one of the biggest advancements in treatment for wrist fractures. During this procedure, a surgeon enters the skin from the palm side and screws a plate to the radius in order to hold the fracture in place, allowing the patient to use their fingers and hand while the fracture heals. Less soft tissue may be disturbed with the newer approach, leading to a faster recovery. A person should ask the doctor if this surgery is appropriate for them in case they have a distal radius fracture.

External fixation devices:
An external fixation device is a set of metal bars outside the skin that are attached to pins that go through the skin and insert into bone. This device could be recommended for some injuries because it provides stability during healing. However, there is a great risk of infection around the surgical pins connected to the external fixation device. Usually, this device is removed after about six to eight weeks.

MEDICATIONS:
A person may be recommended some over-the-counter pain relievers, such as ibuprofen  or acetaminophen  or a combination of both in order to reduce pain and inflammation. They may also need to take a prescription opioid medication, such as codeine for a few days in case they're experiencing severe pain.
Ibuprofen should be avoided for some fractures because some studies have suggested that NSAIDs (nonsteroidal anti-inflammatory drugs) including ibuprofen might slow down healing. So a person should ask their doctor before taking any medications.

REHABILITATION:
Rehabilitation begins soon after initial treatment. Most of the time, while the person is still wearing a cast, it is very important to begin some motion in order to minimize stiffness in the hand. After removing the cast or splint, additional rehabilitation exercises or physical therapy will be recommended in order to reduce stiffness and restore movement in the injured area. Depending on the severity of the injury, it can take several months to regain full use of the affected hand or finger.

Prognosis:

Not Available

Expert's opinion

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