What is the wrist?

The wrist is a joint in the distal (lower) part of the arm consisting of eight small bones called the carpal bones that connect to the distal radius and ulna bones of the forearm. It allows the hand to move by bending, straightening, or rotating.

The eight carpal bones of the wrist are:

• Scaphoid, Lunate, Triquetrum, Pisiform, Hamate, Capitate, Trapezoid, and Trapezium

What causes wrist fractures?

Wrist fractures are very common in children and teens, typically occurring during a fall on an outstretched hand facing backwards.

The most common type of wrist fracture occurs at the distal radius (forearm bone on the thumb side), but the carpal bones may also be involved in wrist injuries. The scaphoid is the most commonly fractured carpal bone.

Common causes of wrist fractures include:

• A fall on an outstretched hand while running or playing
• Collisions or direct blows to the wrist (contact sports, car wrecks, etc.)

Common Types of Pediatric Wrist Fractures:

Physeal Fracture (Distal Radius or Ulna Growth Plate)

Physeal fractures involve the growth plate (physis) at the distal end of the radius or ulna in the forearm. Physeal distal radius fractures are the most common wrist fracture in children under the age of 16. With proper treatment, physeal fractures typically heal well in young children due to the great amount of remodeling potential in the area.

Carpal Fractures

Any of the eight carpal bones have the potential to be fractured, but the most commonly injured bones are the scaphoid, the lunate, and the triquetrum.

Signs and Symptoms:

A broken wrist will typically manifest with immediate pain over the wrist area. Other symptoms may include:

• Swelling and bruising along the wrist
• Difficulty moving, gripping, or squeezing the hand or wrist
• Tenderness to touching the wrist
• A visible deformity of the wrist

Diagnosis:

A Campbell Clinic orthopedic physician will diagnose a fractured wrist after physical exam and X-ray imaging. The doctor will ask about the injury and associated symptoms. During the physical exam, the doctor will test for signs of vascular and nerve damage and may also apply gentle pressure along the wrist to determine where the fracture is.

After performing a physical assessment, the physician will order an X-ray of the affected wrist to confirm diagnosis and locate the exact area of fracture along the wrist. In cases with multiple fractures or complications, a CT scan may be necessary.

Treatment:

Treatment plans for wrist fractures depend on the type and severity of the fracture. A Campbell Clinic orthopedic surgeon will work with the patient and family to create a tailored treatment plan.

Most wrist fractures can be treated without surgery, using a cast or brace. More complicated or severe cases may require surgery.

Non-Surgical Treatment:

If there are no major complications and the bone is still properly aligned, treatment of a fractured wrist usually consists of the following:

• Wearing a cast or splint to protect and support the wrist
• Using over the counter medication to manage pain
• Physical therapy after cast removal (as directed by your physician)

If the bone is not properly aligned, the orthopedic physician may need to perform a closed reduction, in which the bone is manually aligned without cutting skin. This procedure can be painful; so, typically some form of anesthesia will be recommended.

Usually the child will need to be in a cast or splint for 5-8 weeks depending on the severity and location of the fracture. The physician will recommend follow up appointments and X-ray imaging to make sure the bone is properly healing.

Surgical Treatment:

Surgery may be indicated in cases of severe or complicated wrist fractures.

Examples of complicated fractures include:

• Severely displaced fractures- the bone has shifted and must be surgically corrected
• Compound (open) fractures- the bone has broken through the skin
• Comminuted fractures- the bone has broken into several small pieces

During surgery, the physician will make a small incision over the affected area and fix the positioning of the bone to re-align where it broke. Special pins, screws, and plates may be used to hold the bone in place until it heals. Depending on the case, these plates and screws may be removed after the bone has properly healed.

After surgery, a cast or splint will be used to stabilize and protect the bones for 4-8 weeks while they heal. Gentle motion exercises and physical therapy may be suggested by the physician after the cast has been removed.

Outlook (Prognosis):

In children, the bone will usually reform by 6-8 weeks, at which time physical therapy strengthening exercises may begin, as directed by the orthopedic physician.

It is important to protect the wrist and avoid full activity for 4-6 weeks after the cast is removed to avoid refracture and promote proper healing.

Typically, children can return to full activity after 3 months of recovery, but it is recommended to consult your orthopedic physician prior to returning to sports.

Most children and teens experience a full recovery from wrist fractures with proper treatment, but temporary wrist stiffness and weakness are typical after removing the cast.