Symptoms
Classical symptoms of a broken wrist are pressure pain with the following swelling and pain radiation. As a rule, the classic fracture signs are recognizable. In addition to dislocation, i.e. shifting, these include step formation, soft tissue damage, abnormal mobility and the presence of crepitations (“crunching noise” in the fracture area).
Of course, the character and localization of pain depends on which bone of the wrist is broken. Since a fracture can also affect nerves, it is not untypical for tingling and sensation to occur in the fingers or in certain areas of the hand. In addition, mobility is restricted and there is a feeling of instability.
After a fracture, the affected person often adopts a gentle position of the hand in which the pain is less unpleasant. Apart from this position, however, special incorrect postures can also occur with fractures of the radius. If a bone fragment of the radius is displaced in the direction of the thumb, this results in a malposition of the hand in relation to the forearm, the so-called bayonet position. However, if the fragment is displaced to the extensor side, the whole thing is called a Fourchette malposition.
Therapy
As in most cases, there are 2 treatment options. Either one treats a wrist fracture conservatively or through surgery. Conservative treatment means correction (reduction) followed by immobilization with a plaster cast.
If the fracture is not dislocated, i.e. not displaced, a plaster cast can be applied without surgery. Immobilization with a plaster gives the bony structures sufficient stability and time to grow back together properly. In most cases a wearing period of 4-6 weeks is prescribed.To ensure that the bone fragments grow together properly, regular X-ray checks should be made.
This will help to detect possible shifts or malpositions, e.g. due to too early loading, in time and prevent permanent maladjustment. Like the plaster cast, splinting, too, pursues the goal of achieving fracture healing through immobilization. As soon as a wrist fracture is unstable or it is possibly an open and/or comminuted fracture, conservative treatment is no longer sufficient and surgical therapy is indicated.
Various forms of osteosynthesis are possible: external fixator, wires, screws or plate osteosynthesis. The first mentioned variant is actually only used for open fractures with soft tissue injury and polytrauma. The external fixator is, as the name suggests, a holding system (“fixator”) from the outside (“external”).
Here, screws for reduction and retention are fastened at at least 2 points, for example in the radius, in order to connect them externally via a force carrier, usually a rigid metal rod. However, a wrist fracture is much more frequently treated with wires or plates. A fracture of the radius without major displacement and without involvement of the joint surface is reduced and fixed with wires, more precisely with so-called Kirschner wires.
The advantage of wires is that it is a minimally invasive procedure, since the wires are attached to a single point. With this variant, however, it is important to ensure that the arm and wrist are subsequently immobilized with a plaster cast, since the wires are movable and therefore cannot guarantee complete stabilization. This is accompanied by the risk that the range of movement may cause a new displacement.
Immobilization and protection is therefore very important here. The last and most frequently used option is to treat the distal radius fracture with a volar (on the palm side) angular stable plate. The plate is fixed with screws on the flexion side.
In contrast to the treatment with Kirschner wires, this procedure is more invasive and therefore cannot be performed on an outpatient basis, which is possible with Kirschner wires. A major advantage of the volar, angular stable plate is the early functional loading capacity, which can be performed without plaster in comparison to all other forms of osteosynthesis. A scaphoid fracture can be treated both conservatively and surgically.
There are very special screws for surgical therapy, so-called Herbert screws. The special feature of the Herbert screw is the presence of a double thread at each end, so that the screw must be completely countersunk in the bone. Even if the screw ensures good stability, a plaster cast should be worn afterwards.
