WRIST FRACTURES

The wrist is a structure which is formed articulation of 8 small bones and two bones in the forearm. Wrist bones are tied with close ligaments. This structure provides the wrist to move comfortably to every direction. Wrist fractures usually occur in falling on the hand while the arm is open. Fractures may occur due to high energy traumas such as traffic accidents, falling from high. Osteoporosis which arises in older people causes bone wearing and becoming more fragile. Wrist fracture may occur with simpler traumas in old osteoporotic patients. The most fragile bone of the wrist is the forearm bone called radius. Pain, swelling, deformity may occur when the fracture forms.  (Figure 1)

Sometimes the fracture may be as not dislocated and sometimes as complete separated bone ends. Sometimes the fracture is multiple and completely dislocated. The treatment varies according to the fracture type. The first to do is to put the wrist on a stable object (wood, cardboard etc.) and to prevent moving more. The fracture is detected after the radiological examination. CT (computerized tomography) is performed if necessary. Detection of the fractured parts may be done as 3D with CT examination. Fractures of the joint face is important in terms of evaluation of the further treatment and the further result. Sense and movement examination should be done with a level that the pain allows. If some of fractured parts are out of the skin (open fracture), infection risk increases.

Even though the fracture treatment is completed, those who have such fractures should be hospitalized and antibiotic treatment should be given.
The patient’s age, activity level, job, hobbies, whether it is the main used hand, existence of previous wrist trauma, and other medical problems should be evaluated for the treatment decision. In radiological examination, whether the fracture extends into the bone, whether multiple fragmented fracture is present, whether the fracture is dislocated, if osteolysis is present and if the fracture is stable should be evaluated.

The best treatment decision should be taken by combining all these factors.

If the fracture is not dislocated, fixation by a plaster cast is enough. Fracture fixation period (between 3-5 weeks) is determined according to age and fracture type of the patient. If the fracture is not dislocated, to locate the fracture is tried in suitable situations after fracture evaluation. If it's possible, whether the fracture is located may be seen via a tool called scopy that may do radiological examination immediately, and if the fracture is in a suitable position, plaster may be done. If scopy is not present, radiological examination is performed after the plaster and fracture position is evaluated with recurrent films. If continuation of the treatment with the plaster is decided, radiological examination should be run after 3 weeks and whether the fracture position is dislocated should be followed. Plaster is removed 5-6 weeks after.

If the fracture is considered as multiple, with intra-articular extension and unstable, surgery is decided, as well as regarding the general condition of the patient.

In surgical treatment,

  •  After fracture correction, fixation with pins from outside under the control of the scopy and plaster
  • Fixation with materials (external fixator) which is placed on pins placed on both side of the fracture from outside
  • Correction of fractured parts by opening surgically and fixation by plaques and screws after then may be performed.

Arthroscopy may be used to evaluate the joint surface in some cases that intraarticular fracture is detected. Fracture stabilization is increased by placing bone parts (bone graft) which is taken from other parts of the body in multiple fractures and especially inpatients with osteolysis and bone setting may be accelerated.

The plaster is removed after the bone setting. There is movement limitation possibility after removing the plaster. Physiotherapy is very useful in this period. Difficulty, pain and swelling during using the wrist occur for a while. This varies due to personal factors.

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