But, it’s only a broken wrist.
“That’s an understatement,” according to noted hand and upper limb orthopedic surgeon Alejandro Badia MD, who says management of wrist fractures, especially commonly occurring distal radius fractures — those involving the forearm’s largest bone (the radius bone) where it joins the wrist (distal end) — can often prove complicated and require a specialist experienced in musculoskeletal disorders.
“If at all possible, patients with a suspected wrist fracture should avoid hospital emergency rooms and, instead, seek out an orthopedic specialist for proper evaluation and treatment of the injury. A broken wrist is to be taken seriously and treated by a specialist to prevent malunion, a case where the bone heals improperly,” states Dr. Badia, founder and chief medical officer of the Florida-based Badia Hand to Shoulder Center and OrthoNOW®, a network of immediate care Orthopedic Centers in Florida. Dr. Badia adds that if treated properly, the prognosis is great and the patient should not have wrist pain once the fracture heals.
Physicians must thoroughly understand differences and distinctions in fracture patterns.
They must also understand their management and complications among varying age groups and be well versed in the anatomy of the forearm and wrist. “Such knowledge is particularly important today because the incidence of distal radius fractures continues growing worldwide,” says Dr. Badia, whose expertise includes treatment of the hand, wrist and upper limb. Some scientists contend the increase in these fractures is due to longer life expectancy, an aging population and extension of active lifestyles well into old age; others blame environmental and even dietary factors.
Distal radius fractures represent about 18 percent to 20 percent of all broken bones in the United States — about 250,000 fractured radius bones treated annually. These fractures most often happen when a person falls forward with arms and hands outstretched – while running on the playground or participating in sports and other physical activities.
Among older individuals, however, especially those with osteoporosis, a condition associated with thinning and loss of bone, a distal radius fracture may occur simply from some “low-energy trauma.” Moreover, older people are at a higher risk of falling due to poor balance and strength. A study published in a January 2019 issue of Orthopaedics indicates that distal radius fractures are “the second most prevalent fracture” in persons 60 years of age and older and affect approximately 85,000 elderly Americans annually.
Management of a fracture involving osteoporotic bone can prove especially challenging,” Dr. Badia says, adding that a distal radius fracture may be a sign that a patient has osteoporosis or osteopenia — loss of bone density.
Besides age, risk factors for distal radius fractures include lack of mineral density in the young, growing bones of preadolescent and adolescent children, gender, even smoking and obesity, according to studies. Post-menopausal women are more susceptible than men, in part because of shifts in their hormonal levels.
Treatment of distal radius fractures varies depending on how the type of fracture.
An extra-articular fracture — one that occurs above the wrist joint, about an inch from the end of the forearm bone – may just need four to six weeks of casting and later intermittent splinting for a stable fracture or a non-displaced one. The concept of “nonsurgical resetting” of the distal radius has largely fallen out of favor since many displace back to original position, Dr. Badia says. Hence, the more significant or complex fractures, such as highly fragmented fractures, open injuries in which the broken bone punctures the skin, fractures that extend into the wrist joint, or fractures that damage a nerve, will typically require surgical management.
Surgery involves manipulation and realignment of the broken bones and use of an internal plate and screws or an external device to keep the wrist aligned, Dr. Badia explains, generally done in an outpatient environment and with block anesthesia as general anesthesia usually not needed. The external fixator device, a bit cumbersome and even scary, has almost been completely replaced with the much more anatomic and aesthetic internal fixation procedure. Most plates are now placed on the palmar (volar) side of the wrist, a concept which Dr. Badia helped popularize nearly 20 years ago after his work in Europe, biomechanical studies and his early association with a like-minded colleague who developed a company specifically to serve this advance in technique.
The wrist anatomy is complicated – more complicated, to be sure, than a knee or hip joint,” Dr. Badia says. “That’s why it’s paramount a wrist injury be addressed by a specialist.”
An orthopedic surgeon, he says, can help minimize complications during recovery, like malunion of the broken bones, compromised wrist strength or range of motion, development of arthritis where the fracture occurred, injury to wrist-joint nerves and ligaments, or ongoing pain. Even the authors of the online chapter on distal radius fractures recommend that wrist-fracture patients initially seen in the hospital emergency room or primary care doctor’s office be referred to an orthopedic specialist within “an appropriate time frame.”
Of course, the best treatment for distal radius fractures is to be as careful and mindful about your movement and balance as possible to prevent falls. That’s why Dr. Badia offers these tips:
- Consult with an orthopedic specialist or exercise physiologist about activities for strengthening the wrist joints and other upper limbs.
- Eat a healthy diet, with sufficient amounts of calcium to build strong bones.
- Get out into the sunlight for some vitamin D. Vitamin D helps the body absorb calcium.
- If 60 years of age or older, request testing for osteoporosis.
- Stop smoking. If overweight, lose it.
Because a fracture of the wrist is not just a fracture. It truly can become a major problem,” Dr Badia says.
Alejandro Badia, MD, FACS, internationally renowned hand and upper-limb surgeon and founder of Badia Hand to Shoulder Center and OrthoNOW®, a network of walk-in orthopedic care clinics. He is a member of the American Society for Surgery of the Hand, American Association for Hand Surgery and the American Academy of Orthopedic Surgeons. Dr. Badia specializes in treating trauma, sports injury, joint reconstruction, nerve injuries and arthroscopic surgeries. He’s the author of the upcoming book, “Healthcare from the Trenches,” an insider account of the complex barriers of US Healthcare from the providers and patients’ perspective. www.OrthoNOWcare.com and drbadia.com.