A broken wrist usually results from a fall onto an outstretched hand. The two most common injuries that result are a broken scaphoid bone or a broken lower arm bone (distal radius). Usually, if the wrist is bent 90 degrees or more when it hits the ground, the scaphoid bone will break. If the angle is less than 90 degrees, the lower arm bone will break.

Wrist problems are evaluated and treated by hand specialists at New England Hand Associates

Broken Scaphoid Bone

About 60 percent of all wrist fractures involve the scaphoid bone. The bone is shaped like a cashew nut and is located on the thumb side of the wrist close to the lower arm bone. Unfortunately, someone with a broken scaphoid may think the wrist is just sprained, because there is usually no obvious deformity and little swelling. Symptoms include pain and tenderness on the thumb side of the wrist, pain when gripping and a deep, dull ache in the wrist. After a fall onto a wrist, it's important to have the wrist examined as soon as possible. Untreated scaphoid fractures often do not heal, which can eventually lead to wrist arthritis.

Scaphoid fractures may be difficult to see on an initial X-ray. But if the physician suspects a broken scaphoid based on the patient's description of events and a physical examination, he or she may immobilize the wrist in a cast or a splint for several days. Follow-up X-rays taken a week or more later can confirm the diagnosis. MRI, CT scans or bone scans may be required to make a correct diagnosis.

Treatment depends on the extent of the injury and may require a cast or surgery. Healing time can range from six weeks to six months, depending where in the bone the break has occurred. A break in the lower portion of the scaphoid takes longer to heal due to poor blood supply. If a cast is used for treatment, it is checked regularly. Following cast treatment or surgery, rehabilitation is begun to restore strength and range of motion.

Even with immediate attention, not all scaphoid fractures will heal. This nonunion can be repaired with a surgical bone graft and internal pins or screws.

Distal Radius

Distal radius fractures are among the most common bone injuries and often occur when a person falls forward and lands heavily on an outstretched hand. One of the two arm bones, the radius, cannot support the weight and breaks just above the wrist joint. The break, also called a Colles' fracture, is named after Irish surgeon Abraham Colles (1773-1843) who first described the condition.

This fracture is often painful, sending most patients to seek immediate medical attention. It is typically seen in older patients with osteoporotic bone. Soft, osteoporotic bone can make it difficult to treat this break, leading to a malunion (crooked wrist), pain and loss of strength. In many cases, this fracture may be treated with a closed reduction (pushing maneuver) and a cast. This procedure may be done in the emergency room or the hand surgery clinic.