Wrist Sprains And Fractures
What are sprains?
A sprain is an injury to a ligament. Ligaments are the connective tissues that connect bones to bones; they could be thought of as tape that holds the bones together at a joint.
How do wrist sprains occur?
These types of injuries are common in falls and sports. The wrist is usually bent backwards when the hand hits the ground such as when someone slips or trips and falls. These injuries also frequently occur during sports such as football and snowboarding. After injury, the wrist will usually swell and may show bruising. It is usually very painful to move.
| 
|
What are the most common types of wrist sprains?
The most common ligament to be injured in the wrist is the scapho-lunate ligament. It is the ligament between two of the small bones in the wrist, the scaphoid bone and the lunate bone. There are many other ligaments in the wrist, but they are less frequently injured. Sprains can have a wide range of severity; minor sprains may have minimal stretch of the ligaments, and more severe sprains may have complete ruptures of the ligament(s).
How are these injuries treated?
Initially your doctor will examine your wrist, to check its flexibility and stability and to see where it hurts. X-rays are taken to check the alignment of the wrist bones and to check for any fractures. Occasionally other studies such as Magnetic Resonance Imaging (MRI) may be performed to help determine the diagnosis. Treatment may range from immobilization in a splint or cast to surgery. Surgery may consist of arthroscopic or open surgery. Arthroscopic surgery is performed through small (3-4 millimeter) holes in the skin where a camera and other special instruments are placed inside the wrist to confirm the diagnosis and potentially treat the ligament injury. Some injuries require open surgery in which an incision is made to repair and/or reconstruct the ligament. A variety of methods exist, which could include metal pins, screws, and other specialized devices. Patients are usually placed in a splint or cast after surgery which may need to remain on for 6-12 weeks after surgery. Your doctor will determine the best course of treatment.
Chronic injuries
The term “chronic” refers to an old injury of greater than several months to years. If there is no or minimal cartilage damage, the ligament may be reconstructed as discussed above. If there is moderate to severe cartilage damage (arthritis), symptoms may be pain, stiffness, and swelling. These may be first treated with splinting and non-steroidal anti-inflammatory medicines, and later with cortisone injections. If these treatments fail, surgery may be an option. This may be a partial wrist fusion, removal of arthritic bones (“proximal row carpectomy”), wrist replacement, or complete wrist fusion. Your doctor will determine the best course of treatment.
Associated injuries
Occasionally fractures occur along with wrist sprains.These may require additional surgery to repair the fracture with metal pins, screws, or plates. Cartilage damage may also be present which does not show up on the x-ray.
What you can expect from these injuries
Despite optimal treatment, wrist sprains occasionally result in residual long term pain, stiffness, and swelling. The wrist is a complex group of bones, cartilage, and ligaments that are in a delicate balance for precise movements. Injury can upset this balance and damage previously well-tuned moving parts.
Future treatments
There is much research underway searching for better methods to treat these serious injuries.They include stronger and more precise ligament reconstructions using either local tissues (tendons) or distant tissues (ligaments from the hand or foot).
What is a wrist fracture?
The wrist is made up of eight small bones and the two forearm bones, the radius and ulna. The shape of the bones allows the wrist to bend and straighten, move side-to-side, and rotate, as in twisting the palm up or down. A fracture may occur in any of these bones when enough force is applied, such as when falling down onto an outstretched hand. Severe injuries may occur from a more forceful injury, such as a car accident or a fall off a roof or ladder. Osteoporosis, a common condition in which the bone becomes more brittle, may make one more susceptible to getting a wrist fracture. The most commonly broken bone of the wrist is the radius. Many people think that a fracture is different from a break, but they are the same.
When the wrist is broken, there is pain, swelling, and decreased use of the hand and wrist. Often the wrist appears crooked and deformed. Fractures of the small wrist bones, such as the scaphoid, are unlikely to appear deformed. Fractures may be simple with the bone pieces aligned and stable. Other fractures are unstable and the bone fragments tend to displace or shift, in which case the wrist is more likely to appear crooked. Some fractures break the normally smooth, ball bearing-like joint surface; others will be near the joint but leave the joint surface intact. Sometimes the bone is shattered into many pieces, which usually makes it unstable. An open (compound) fracture occurs when a bone fragment breaks through the skin. There is some risk of infection with compound fractures.
How are wrist fractures evaluated?
Examination and x-rays are needed so that your doctor can tell if there is a fracture and to help determine the treatment. Sometimes a CT scan or MRI may be used to get better detail of the fracture fragments and associated injuries. In addition to the bone, ligaments (the structures that hold the bones together), tendons, muscles, and nerves may be injured as well when the wrist is broken. These injuries may need to be treated in addition to the fracture.
| 
|
How are wrist fractures treated?
The pattern of the fracture, whether it is displaced or non-displaced, and whether it is stable or unstable are all factors in determining the treatment. Other important considerations include your age, overall health, hand dominance, work and leisure activities, the presence of any prior injury or arthritis, and any associated injuries.
A splint or cast may be used to treat a fracture that is not displaced, or to protect a fracture that has been set. Other fractures may need surgery to properly set the bone and/or to stabilize it. Fractures may be stabilized with pins, screws, plates, rods, or external fixation. External fixation is a method in which a frame outside the body is attached to pins which have been placed in the bone above and below the fracture site, in effect keeping it in traction until the bone heals. Sometimes arthroscopy is used in the evaluation and treatment of wrist fractures. Your hand surgeon will determine as to which treatment is the most appropriate in your individual case.
On occasion, bone may be missing or may be so severely crushed that there is a gap in the bone once it has been re-aligned. In such cases, a bone graft may be necessary. In this procedure, bone is taken from another part of the body to help fill in the defect. Bone from a bone bank or synthetic bone graft substitutes may also be used. While the wrist fracture is healing, it is very important to keep the fingers flexible, provided that there are no other injuries that would require that the fingers be immobilized. Otherwise, the fingers will become stiff, hindering the recovery of hand function. Once the wrist has enough stability, motion exercises may be started for the wrist itself. Your hand surgeon will determine the appropriate timing for these exercises. Hand therapy is often used to help recover flexibility, strength, and function.
What kind of results can I expect from treatment for wrist fractures?
Recovery time varies considerably, depending on the severity of the injury, associated injuries, and other factors as noted previously. It is not unusual for maximal recovery from a wrist fracture to take several months. Some patients may have residual stiffness or aching. If the surface of the joint was badly injured, arthritis may develop. On occasion, additional treatment or reconstructive surgery may be needed.
Credit: National Institute of Health.