With a good 20-25% of all fractures, the fracture of the distal radius, or colloquially known as wrist fracture, is the most common fracture of the wrist in the entire body. On the one hand, the carpal bones are very fine and unstable bones that can be damaged by even the slightest application of force. On the other hand, the exposed anatomical position of the hand and wrist leads to a higher risk of injury.
Typically, older patients are affected by a wrist fracture, but athletes, especially snowboarders, can also be injured if they fall down the wrong way. Since wrist fractures are usually complicated fractures, conservative methods are usually not sufficient to treat the fracture optimally. There is no way around surgery. But how is such a wrist fracture surgery performed, what are the risks, and what are the chances of recovery?
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First of all, in recent years, the guideline has also become established in trauma surgery that surgery should only be performed when all other possibilities have been exhausted, quasi as “ultima ratio”. Accordingly, a conservative treatment option should be considered first and foremost. In the case of a wrist fracture, conservative treatment is possible if the fracture is not dislocated, i.e. the edges of the fracture are not displaced from each other.
If the bone fragments are displaced relative to each other, a reduction must be performed first: For this purpose, the bone fragments are placed on tension, i.e. they are pulled apart. After approx. 10 minutes of traction, the bone fragments are then repositioned in relation to each other from the outside.
Then a plaster cast must be applied for at least 6 weeks, as well as a regular follow-up X-ray check to prevent the reduced bone fragments from sliding back. Conservative treatment is logically not possible for multipart fractures in which splinters or tiny bone fragments may still have formed. These would be impossible to bring back into the correct position “from the outside”.
Therefore, surgical procedures must be used in such cases: A distinction is made between open and closed reduction. In closed reduction, the wrist fracture is first x-rayed to get an idea of the extent and position of the bone fragments. The individual bone fragments are then fixed together with wires.
These wires are also called “Kirschner wires” and remain in the bone during the healing period. The fact that they press the bone fragments firmly together promotes healing. It is similar to gluing two pieces of wood together with a wooden press.
The disadvantage of this method, however, is that the wires are not so stable that they could withstand the everyday forces. For this reason, a plaster splint must be applied for about 6 weeks. The incisions for the Kirschner wires are usually made on the inside of the wrist through small skin incisions.
After 6 weeks, the wires must also be removed again, but this can be done under local anesthesia. The second surgical option is open reduction: It is usually used for complicated fractures or when the bone is already very unstable due to osteoporosis. For this purpose, the bone pieces are fixed with a plate.
The plate is made of titanium and is several millimeters thick. It is preferably attached to the flexion side of the wrist – i.e. the inner side of the wrist. It is then located directly under the skin, and can often be palpated from the outside.
The bone fragments are placed on it like a jigsaw puzzle and firmly screwed together. This ensures immediate exercise stability, so that physiotherapy can be started days after the operation. Less frequently, the plate is also used on the extensor side of the wrist, but since more tendons run here, this method is reluctantly chosen: The tendons supplying the fingers are often irritated. The plate is left permanently in the wrist, since removal is usually not necessary. The operation is performed under local anesthesia, and lasts from half an hour to a full hour, depending on its complexity.
