Wrist Fractures

Wrist fractures are common among older people. These fractures often result from a fall on an outstretched arm. The most common wrist fracture, called Colles' fracture, occurs near the wrist in one of the arm bones (radius). Osteoporosis increases the likelihood of a wrist fracture.

Symptoms include pain, swelling, and tenderness. Often after a fracture, the wrist is obviously out of line.

Treatment

A splint or cast is often used to immobilize the wrist. If the fracture is badly out of line, bone fragments are put back in place first. A local anesthetic is usually needed. If the fragments are unlikely to stay in place, metal pins, wires, or screws may be inserted to hold the bone fragments together. External fixation (with a metal frame and pins extending outside the body) or internal fixation (with screws attached to a metal plate inside the body) may be used for the most severe fractures. After either procedure, a splint may be used to provide additional support. The pins or screws used for external or internal fixation are painless once inserted. They may be left in place for weeks. In older people, the plate used for internal fixation may be left in place permanently.

See the figure Holding the Wrist Together: External Fixation.

A cast is usually worn for 3 to 8 weeks. The fingers, elbow (if free), and shoulder on the affected side should be moved daily to prevent stiffness. The hand should be rested in an elevated position to control swelling.

A cast or metal frame with pins can be awkward and throw a person off balance. These devices can interfere with sleep. Special foam pillows to elevate the arm may help a person sleep more comfortably. With one arm immobilized, some activities are impossible.

Physical therapy can speed recovery. Comfort, flexibility, and strength of the wrist continue to improve for 6 to 12 months after the fracture. However, older people may not regain full mobility of the wrist joint. Some people develop carpal tunnel syndrome after a wrist fracture.