Introduction
Wrist fractures are common injuries and often require surgical treatment. The most common injuries are fractures of the end of one of the forearm bones (the distal radius) or the scaphoid – one of the carpal bones that make up the wrist joint.
Indications
Fractures that are out of anatomical position are often best treated surgically both to improve healing time, prevent non-union, and give people the best chance of returning to pre-injury function.
Preoperative Instructions
Wrist fractures are often treated urgently, with an admission to hospital via the emergency department. In less severe fractures, surgery may be performed in a more elective fashion with a planned admission for day-surgery within a week or two of the injury.
Procedure
For distal radius fractures, an incision is made on the palmar side of the wrist and the fracture is exposed. The fracture is then reduced (pulled into the correct position) and then held with a metal plate and screws. X-rays are taken to confirm the position of the bone and the wound is closed. Scaphoid fractures are usually treated with a single screw passed across the fracture, either from the front of back of the wrist depending on the fracture.
Postoperative Instructions
Distal radius fractures will be immobilized in a plaster for 1-2 weeks followed by a month of exercises with a hand therapist before starting strengthening. Scaphoid fractures are usually immobilized for 6-8 weeks before exercises are started.
Risks
Sometimes distal radius fractures necessitate placement of the plate in a position than can irritate the overlying tendons, and the plate then needs removed once the bone has healed. The biggest risk with scaphoid fractures is non-union (failure of the bone to heal) with occurs in around 5% of cases. In this situation, further surgery is usually required.
Treatment Alternatives
Most fractures can be treated conservatively in a splint or cast. Surgery is offered when there is a specific gain either in healing time or in expected functional outcome. Dr Stewart can go over the pros and cons of surgery for your specific injury.