Broken wrist

Wrist anatomy

Under the term "Wrist" one understands the collective term for 2 separate joints.

For one thing, this is that proximal (i.e. near the center of the body) - and on the other hand that distal wrist.
The proximal wrist is also called "Articulatio radiocarpalis“And is made up of the Forearm bones, the so-called spoke (lat. radius), and the proximal carpal bones (lat. Os carpalis) together.
It is because of the 2 degrees of freedom and its shape around a Ellipsoid / egg joint. A distinctive feature of the proximal wrist is the presence of a small one Intermediate joint washer (Articular disc).
Actually, the disc is one of the joints between Cubit and spoke, but is at the "Articulatio radiocarpalis“Involved because of its location.

The distal wrist - or also "Articulatio mediocarpalis“- denotes the articulated connection between the series of proximal and distal carpal bones. These include the following bones:

• Scaphoid (Os scpahoideum)
• Moon leg (Lunate bone)
• Triangular leg (Os triquetrum)
• large polygonal leg (Trapezium)
• small polygonal bone (Os trapezoideum)
• Head leg (Os capitatum)
• Hook leg (Hamate bone)

In contrast to the proximal wrist, the distal wrist is due to Ligaments and muscles less agile and functional Hinge joint. Apart from the carpal bones and the radius (radius), the ulna is also often affected when it comes to fractures in the wrist area.

causes

Traumatic conditional Wrist fractures are most common.
The break varies depending on the mechanism of the accident. At a Fall on hand is typically the spoke (radius) affected.
Depending on how the hand position is at the time the force is applied in a fall, one can distinguish between breaks in the bent and extended position. In Extension position (i.e. when the hand is stretched), the so-called Colles fracture of the radius.
A Smith fracture results from a fall on the bent hand. This is less common because a fall occurs reflexively Support movement, so a stretched position, the hand comes.

Affected are frequent children and elderly. The latter group is exposed to an increased risk of falling due to age-related immobility. In addition, old bones are due to osteoporosis more unstable and brittle than young, healthy bones.
At the Sports or direct violence wrist fractures can also occur. The fracture of a carpal bone, the scaphoid bone, i.e. the so-called fracture, is also typical Scaphoid fracture.

Symptoms

Classic symptoms if your wrist is broken Tenderness with the following swelling and Radiation of pain.

Usually they are classic Fraktur characters recognizable. In addition to the Dislocation, so the mobility that Step formation, Soft tissue damage, abnormal mobility and the presence of Crepitations (“Crunching sound” in the fracture area).

Of course, the nature of the pain and the location of the pain depend on which one bone of the wrist is broken.
Because of a break too annoy It is not atypical for it to be affected Tingling sensations and Paresthesia comes in the fingers or in certain areas of the hand.

Besides, the Limited mobility and there is a sense of instability. Often, after a fracture, the affected person becomes one Relieving posture in the hand, in which the pain is less uncomfortable. Apart from this posture, there can also be special bad postures when the radius come.
If a bone fragment of the radius is displaced towards the thumb, the hand is misaligned in relation to the forearm, the so-called Bayonet position. However, if the fragment shifts to the extensor side, the whole is called Fourchette deformity.

Appointment with a hand specialist?

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
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In order to be able to treat successfully in orthopedics, a thorough examination, diagnosis and a medical history are required.
In our very economic world in particular, there is too little time to thoroughly grasp the complex diseases of orthopedics and thus initiate targeted treatment.
I don't want to join the ranks of "quick knife pullers".
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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therapy

As in most cases there is 2 therapy options.
Either you treat a broken wrist conservatively or through surgery.

Under the conservative treatment one understands the correction (Reduction) with subsequent immobilization using a plaster cast.
If the fractures are not dislocated, i.e. not displaced, the restoration is plaster without surgery possible.

The Immobilization The plaster of paris gives the bony structures enough stability and time to literally grow together again. In most cases the wearing time is 4-6 weeks required. To make sure that the bone fragments grow together properly, regular X-ray controls occur.
This way, possible shifts or misalignments, e.g. due to too early exposure, recognized in time and a permanent malformation be prevented. The splint, like the plaster of paris, also aims to heal the fracture through immobilization.

Once a wrist fracture unstable is or it is possibly an open and / or Comminuted fracture In this case, conservative care is no longer sufficient so that surgical therapy is indicated. There are different forms of Osteosynthesis in question:
External fixator, Wires, screws - or Plate fixation.

The first mentioned variant is actually only used with open fractures Soft tissue injury and Polytrauma used. As the name suggests, the external fixator is a Holding system ("Fixator") of Outside ("External").
Here will be Reduction screws and Retention For example, it is fastened in at least 2 places in the spoke, in order to then connect them to one another outside via a force carrier, usually a rigid metal rod.

However, a broken wrist is much more common Wires or plates provided. A fracture of the spoke without major displacements and without involvement of the articular surface is repositioned and fixed with Wires, more precisely with so-called Kirschner wires. The advantage of the wires is that it is a minimally invasive surgery acts because the wires are punctually attached to one point. With this variant, however, you have to make sure that the arm and wrist are then connected to one Plaster immobilized as the wires are movable and therefore cannot guarantee complete stabilization. This is accompanied by the risk that the freedom of movement can lead to another shift. Resting and rest is very important here.

The last and most frequently used variant is the supply of the distal spoke fracture with a volar (on the palm side) angular stable plate. The plate is fixed with screws on the flexion side.In contrast to the treatment with Kirschner wires, this procedure is more invasive and therefore cannot be carried out on an outpatient basis, which is possible with Kirschner wires. A great advantage of the volar, angle-stable plate is that early functional resiliencecompared to all other forms of osteosynthesis without plaster can be done.

A Scaphoid fracture (Scaphoid fracture) can be treated both conservatively and surgically. There are very special screws, so-called Herbert screws, for surgical therapy. The specialty of the Herbert screw is the presence of a double thread at the respective ends, so that the screw in the bone must be completely sunk. Even if the screw has good stability, a plaster of paris should be worn afterwards.

Duration

In the conservative therapy should the plaster of paris like 4-6 weeks be worn.
In the meantime, it's important Thumb and fingers to move with it the Musculature is not completely broken down despite the immobilization, but also to promote blood circulation.
In addition, it must be checked regularly whether both the sensitivity, as well as the blood circulation and motor skills are preserved.
By fdisgusting plaster of paris one of the factors can be negatively influenced, which requires an immediate change and new installation of the plaster. After the cast has been removed, mobility is usually possible again and there is sufficient stability. With heavier loads should only after 8-12 weeks to be started; this also includes any sporting activities.

After a surgical treatment, the healing process or the follow-up treatment varies a little.
The Kirschner wire supply as I said, always goes hand in hand with wearing a cast. The wires can then be removed after the bone has healed, i.e. approximately after 4-6 weeks, respectively.
However, a volar, locking plate can lifelong Remain in the body as long as it does not cause any discomfort. Earliest removal time should be after 12 months because the stability that can be achieved is insufficient and as best as possible beforehand.
The follow-up treatment of a Herbert screw supply does not differ much from the others: the plaster of paris is removed afterwards 4-6 weeks and the load should be increased slowly with, if necessary, supportive physiotherapy.

In summary, it can be said that the Healing process besides the various Osteosynthesis variants depends a lot on how cooperative the patient itself is.
In conservative therapy in particular, it is essential to adhere to Immobilization and freedom from stress is held. Otherwise, the risk of a renewed shift, persistent instability or the incorrect fusion of bones is otherwise very high.
It is important to consult the doctor receiving treatment after surgery Aftercare and possible physiotherapy treatment to deal with in order to guarantee the best possible healing.
Uncomplicated fractures of the wrist are usually already after 4-6 weeks healed again; more complicated fractures can have one half-year healing process entail.

You can find a topic that might also interest you at: Spoke break duration