What happens if I break my wrist and will it need an operation?

Fractures of the distal radius are common following sports injuries or falls. They often occur in people taking part in high energy activities, or in people with lower energy falls who have thin bones as a result of osteoarthritis. The vast majority of distal radius fractures can be managed without surgery, just using a plaster cast or a splint. If your fracture is completely undisplaced and your pain is under control in a splint, then a splint maybe all you need to get over this injury. This can be taken off to allow washing of your hand and to do some gentle exercises to try and reduce the long-term risk of stiffness.

If the fracture has moved apart a little bit in a backwards direction, then it’s often possible for our hand surgery team to gently relocate it for you and hold it there using a plaster cast. We would then talk to you about what the risks of the fracture displacing again might be, and this is usually dependent on how far bent back the bone was at the time of the injury, how weak or strong your bone quality might be, whether the ulna bone is also broken, whether the fracture goes into the joint or has stayed outside of the wrist joint.

If you choose to manage your fracture in a plaster cast, then this will usually be kept in position for between four and six weeks to try and reduce the risk of the bone slipping back again in the future. With mild slips backward, the functional results are often still very good, and although the wrist might always look a slightly different shape, often people return to excellent function without pain, even if the X-ray looks different to how it did before the break.

How do I know if I need an operation?

There are some circumstances where surgery might be recommended for your broken wrist. These include if the fracture goes into the wrist joint and we might worry in the future about the risk of secondary osteoarthritis or wear and tear of the cartilage of the joint. Under these circumstances, we would usually recommend surgery to restore the shape of the joint and try to reduce the risk of cartilage wear in the future. Other reasons why we might recommend surgery include if the bone has gone backwards a significant degree at the time of the injury and we worry that it will drift there despite a plaster cast over the two to three weeks whilst new bone is developing.  Similarly if the bone is tilted forward to any degree because we worry that the muscles that attach at the front of the wrist will continue to pull that block of bone forwards with time, and we would therefore recommend an operation to push the block of bone back into position and hold it there with plates and screws.

What if an operation is recommended?

If surgery is recommended, then this can usually be done as a day case procedure under general anaesthetic or regional anaesthetic (injections around the armpit to the nerves that go down to the hand). A cut will usually be made across the front of the wrist and the tendons and nerves and arteries are gently held out of the way. Our surgeons will then move the bone back into an appropriate position and the plates and screws will be used to hold the position in a safe manner until the fracture heals. These plates are usually made out of stainless steel or titanium. The advantage of surgical fixation is that as long as a stable construct is achieved during the operation (which it will be in the overwhelming majority of cases), you can then start to move your wrist from a few days after the operation, under the care of a hand therapist. The advantage of this is to reduce the long-term swelling that will come about following surgery and following the injury. Initially after surgery, a temporary half-plaster is positioned and you’re encouraged to elevate your hand above the level of the elbow, and to do finger exercises to try and reduce the risk of stiffness of the fingers. Our surgeons will link you with an appropriate hand therapist who can take your care forward, usually starting from one week after the operation.

Will my plate need to be removed again?

The majority of plates we put in for distal radius fractures can stay in for life unless they cause any irritation. If they cause irritation, then you may choose to have your plate taken out in the fullness of time, but we would rather wait 6 to 12 months to allow the bone to fully strengthen up prior to removing any metalwork. This also gives you a chance to work hard at your exercises with your hand therapist so that the range of movement is back to near normal before the metalwork is taken out. This makes rehabilitation following a second operation much easier for you.

There are some circumstances when we might specifically recommend that the plate be taken out. These include if the fracture goes very close to the wrist joint or into the wrist joint, forcing us to select a particular type of plate that is designed to sit over the lip of the wrist joint.

Under those circumstances, the thumb tendon can rub over the leading edge of the plate, and with time, we worry that the thumb tendon might become frayed and even snap. Should this happen, there are reconstructive options, but it’s preferable to avoid this happening in the first place. If you need to have your plate taken out, then this can be done at a time of your choosing to suit your travel plans.

We would go in through the same scar, remove the metalwork and sew the skin back up again. Following this, a plaster cast is not needed and a simple dressing is applied. You’re encouraged to move your wrist as much as possible in the early few days after the operation, under the care of your hand therapist. This is a much easier rehabilitation because you don’t have the pain associated with having a broken bone and so it’s much easier for you to undergo the exercises.

If your broken wrist does need a plaster cast or an operation, then the team at Grosvenor Orthopaedics will be happy to support you through this process.

For more information, or to book appointments, please see https://gop.health/conds_treats/wrist-fractures/

Or you can book directly with one of our Consultant Wrist Surgeons: