Therapy
As with any other fracture, the fracture is treated by immobilization and, if necessary, surgical treatment. If the fracture appears complicated on X-ray (e.g. comminuted fracture), it must be treated with screws and/or plates. For this purpose, a metal plate is screwed onto the bone, which then holds the individual bone pieces together.
This plate can either be left in the bone or removed again after healing is complete. In the case of “simple” straight fractures, the bone is first reduced – i.e. returned to its original, anatomically correct position. This is done by means of a “Chinese finger trap”: one or more fingers are hooked into a device at head height, and the elbow is pulled down by means of weight.
This pulls the fracture apart, and it can be reduced again after about 10 minutes. The fracture is then immobilized with a plaster cast – including the adjacent two joints. In this case from the elbow to the fingers. After about 6 weeks of healing time, the bone has grown together again and can be loaded gently. Painkillers from the NSAID class can be taken to relieve the pain, but these must always be combined with a stomach medicine, as they attack the stomach lining.
Diagnosis
The diagnosis of a fracture of the wrist is made clinically either on the basis of certain or uncertain fracture signs: An x-ray is taken in almost every case for diagnosis, because – if a fracture is present – one would like to be able to assess it more closely. This is particularly important for the type of therapy and assessment of the severity of the fracture.
- Reliable fracture signs are, for example, abnormal malposition of the bone or crunching noises during movement.
- Uncertain fracture signs such as swelling, pain and restricted movement may indicate a fracture, but are not considered conclusive.
Prognosis
Depending on the severity of the fracture, healing can be absolutely uneventful to unfavorable. In the case of severe and complicated fractures, in many cases a restriction of movement in the wrist persists for years. The wrist is a very complicated joint, which is moved many 100 times a day.
It must be able to withstand extraordinary loads and demands. Therefore, the initial state is often no longer reached. Physiotherapy and rehabilitation can be a great support.
With elderly patients, the downright “rotten” structure of the bone is a big problem: screws or plates do not hold in the bone, and when trying to drill into it, there is a risk of further fracture. These operations are therefore not always successful. However, good healing rates are achieved in younger patients with less complicated fractures.
