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WRIST FRACTURE
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What is it?
The wrist is composed of eight bones. These eight bones attach the bones in the forearm (ulna and radius) and the bones in the hand (metacarpals). A wrist fracture is a break in either of the forearm bones or one of the eight wrist bones. It occurs most commonly as the result of a fall on an outstretched hand. It may also occur from a direct blow to the wrist.

Symptoms
Symptoms include pain, swelling, and limited range of motion of the affected wrist.

Sports Medicine Evaluation
Work-up for a suspected wrist fracture begins with an examination of the injured wrist, hand, and thumb, as well as the uninjured wrist, hand, and thumb. This may include an evaluation for local tenderness, motion of the wrist, and presence of any joint deformity. Imaging should be ordered to assist with diagnosis. An x-ray is most commonly ordered, but a CT or MRI may also be needed. At times, a suspected fracture may not be evident on the initial x-ray, so another x-ray in 1-2 weeks may be necessary.

Treatment
Treatment depends on the type of fracture. Typically, a wrist fracture requires immobilization in a cast or splint for 4-12 weeks depending on the fractured bone. Commonly, it is necessary to apply a splint for a few days until the swelling decreases prior to applying a cast. Ice and elevation of the wrist will help reduce the swelling. In addition, anti-inflammatory or other pain medications may be prescribed for pain control. If the bones are crooked, the sports medicine physician may attempt to straighten them prior to applying a splint. If there is significant separation, angulation (crooked appearance), or inadequate healing of the fracture after casting, surgery may be required.

Injury Prevention
Protective wrist splints may help prevent certain types of wrist injuries in specific sports. However, most wrist fractures are the result of accidental falls, and are difficult to prevent. Adequate strength and conditioning to participate in a given sport or athletic activity is always recommended.

Return To Play
Return to play should be overseen by a sports medicine physician to ensure safe and timely return to sport. Follow-up appointments typically include repeat x-rays to assess for bony healing. Most physicians will determine readiness to return to play based on the return of full strength, pain-free full range of motion and the ability to protect the wrist during activity. This takes varying amounts of time, but is usually about 6-8 weeks. Rehabilitation may be needed after casting to assist with stretching and strengthening the wrist to help it return to normal.

AMSSM Member Authors
Mark Kasmer, MD, Matt Gammons, MD

References
Brukner P, Khan K. Brukner & Khan’s Clinical Sports Medicine. 4th Edition. Australia: McGraw-Hill Education; 2012.

Eiff MP, Hatch R. Fracture Management for Primary Care. 3rd Edition. Philadelphia, PA: Elsevier Saunders; 2012.

Koval K, Haidukewych GJ, Service B, Zirgibel BJ. Controversies in the management of distal radius fractures. J Am Acad Orthop Surg. 2014 Sep;22(9):566-575.

Rouzier P. The Sports Medicine Patient Advisor. 3rd Edition. Amherst, MA: Sportsmed Press; 2010.

Category: Bone Health and Fractures, Hand and Wrist,

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