Wrist Fractures: Causes And Treatments

Wrist Anatomy and Wrist Fractures

The wrist is one of the most intricate and essential structures in the human body. Because our hands play such a vital role in daily activities, it’s crucial to address any wrist injuries or potential fractures as soon as symptoms appear.

This article provides a brief overview of common wrist fractures and outlines general approaches to treatment. For optimal care, it’s important to consult a Physiotherapist, General Practitioner (GP), or Specialist for accurate diagnosis and management.

The wrist is made up of nine small bones, collectively known as the carpus, which are held together by ligaments. Two long bones of the forearm—the radius and ulna—connect to one end of the wrist. On the opposite side, the carpal bones articulate with the bones of the thumb and fingers (see Fig A). Numerous tendons and muscles traverse the top (dorsal) and bottom (palmar) surfaces of the wrist, many of which extend into the fingers. Additionally, the wrist contains critical nerves and blood vessels¹.

Most wrist fractures occur as a result of traumatic injuries and are usually accompanied by immediate symptoms. Less commonly, fractures may arise due to underlying conditions such as osteoporosis, which weakens bone tissue and increases susceptibility to breaks. However, this article will focus primarily on traumatic causes.

Fracture Terminology

Medical professionals use specific terminology to describe the characteristics of fractures, including their stability, alignment, and severity:

• Stable vs. unstable
• Displaced vs. non-displaced
• Simple fracture vs. comminuted
• Closed fracture vs. compound (open) fracture

A stable, non-displaced fracture occurs when the bone has broken but remains in proper alignment.

In contrast, a stable, displaced fracture requires re-alignment but does not compromise overall bone stability. These fractures are typically managed with immobilisation through a cast or splint. However, if the fracture is unstable, surgical intervention is usually necessary.

A comminuted fracture involves the bone breaking into three or more fragments. This type often results from high-impact trauma and tends to be unstable.

A compound (or open) fracture is characterized by a wound that exposes the broken bone through the skin, increasing the risk of infection and complications¹.

Causes of Common Wrist Fractures

Several mechanisms can lead to fractures of the distal radius and/or ulna. These include:

• Falling on an outstretched hand (commonly resulting in a Colles’ fracture)
• Motor vehicle accidents, where the hands strike the dashboard, steering wheel, or airbag
• Falling on a flexed wrist (known as a Smith’s fracture)

The scaphoid bone, one of the carpal bones, is particularly vulnerable during a fall on an outstretched hand. Scaphoid fractures represent approximately 79% of all carpal fractures and most frequently affect men aged 20 to 30².

Another type, known as a Barton’s fracture, involves a fracture dislocation of the radiocarpal joint. These injuries typically result from a fall and often necessitate surgery. Unfortunately, even after successful realignment, some cases experience post-operative dislocation³.

Fracture Management

When a fracture remains well-aligned, the preferred treatment involves immobilisation with a plaster cast (POP) or thermoplastic splint. Depending on the severity, immobilisation usually lasts between three and six weeks².

Displaced Wrist Fractures

For displaced fractures, the bones may need to be realigned—a process called closed reduction. This procedure typically involves local anaesthesia or a nerve block, enabling the surgeon to reposition the bones without making an incision. Afterward, the wrist is immobilised with a cast or splint for several weeks while healing progresses².

In cases where the fracture is unstable or severely displaced, a more invasive approach may be necessary. The procedure, known as Open Reduction and Internal Fixation (ORIF), involves surgically exposing the fracture site and using pins, screws, plates, or rods to stabilise the bones. Following surgery, a plaster or partial cast is usually applied. The surgeon typically removes it after a week to assess the surgical site. Rehabilitation often begins within 7–10 days, depending on the fracture’s location and complexity.

Scaphoid Fractures

Scaphoid fractures are particularly challenging due to limited blood supply. In some cases, immobilisation for extended periods is necessary. When healing is unlikely to occur with conservative care alone, surgical pinning may be performed to improve healing outcomes and reduce the risk of complications like avascular necrosis or osteoarthritis⁴.

During the rehabilitation phase, a Physiotherapist will guide your recovery through targeted treatment and exercises. These focus on restoring movement, improving strength, and regaining function in the wrist, thumb, and fingers. The duration of rehabilitation depends on factors such as fracture severity, soft tissue damage, and the length of immobilisation.

If you’re concerned about your wrist injury or recovery progress, speak to your Physiotherapist for a comprehensive assessment and treatment plan.

About the Author: Sophie Halsall-McLennan is a Physiotherapist based in the Geelong & Drysdale region. She is the owner of Fresh Start Physio, holds a Bachelor of Physiotherapy from Charles Sturt University, and brings over 12 years of clinical experience. Sophie is registered with AHPRA and also lectures at Deakin University.

References

1. Brukner, P., & Khan, K. (2009). Clinical Sports Medicine (3rd ed., revised). McGraw-Hill: North Ryde.
2. Skirven, T., Osterman, A., Fedorczyk, J., & Amadio, P. (2011). Rehabilitation of the Hand and Upper Extremity (6th ed.). Elsevier: Philadelphia.
3. Website: www.orthofracs.com
4. Phillips, T., Reibach, A., & Slomiany, W. (2004). Diagnosis and Management of Scaphoid Fractures. Washington Hospital Family Practice Residency, Washington, Pennsylvania.

Disclaimer: This article is provided by Sydney Physio Clinic for educational purposes only and is not intended to replace medical advice. Individuals with concerns regarding wrist fractures should consult a qualified healthcare provider such as a GP, physiotherapist, orthopedic specialist, or sports medicine practitioner.