[其他] Broken Wrist

Information about wrist fractures

What is a wrist fracture?
A broken wrist is the most common fracture in patients under 65 years of age. Usually, doctors are referring to a fracture of the radius (one of two forearm bones) when they diagnose a wrist fracture. When the radius is broken, pain, swelling, and deformity in the area of the wrist joint are common. The most common cause of a broken wrist is a fall on to an outstretched hand

How is the diagnosis of a wrist fracture made?
When a patient comes to the emergency room with wrist pain, and evidence of a possibly broken wrist, the first step is to obtain x-rays of the injured wrist. If the wrist is indeed broken, the x-rays will be carefully reviewed to determine if the fracture is in proper position, and to assess the stability of the broken fragments.

What is the usual treatment for a wrist fracture?
Most often, broken wrists can be treated in a cast. The wrist is one area of your body that is very amenable to cast treatment. If the bones are out of proper position, then some light sedation or local anesthesia may be used so your doctor can reset the fracture. This is called 'reducing' a fracture, and by performing specific maneuvers, your doctor may be able to realign the broken bones.

Which wrist fractures need surgery for treatment?
This is a difficult question to answer, and must be addressed on a case by case basis. Even on an individual basis, orthopedists may differ on their opinion of optimal treatment for a given fracture.

Some of the following are important considerations in determining whether or not surgery is necessary for a broken wrist:

• Age and physical demands of the patient
  If a patient is young and active, every effort will be made to restore the wrist to normal. In some wrist fractures, this may help prevent problems in the years ahead. However, if the patient does not require heavy demands of the wrist, or if the patient is elderly, perfect restoration of the broken bones may not be necessary.
• Bone quality
  If the bone is severely osteoporotic, then surgery may be less beneficial. If plates and screws are used to fix a fracture, the bone quality must be adequate to secure the screws. Surgery is traumatic to the bone, and sometimes the best course of action is to minimize further insult to the bone and treat in a cast.
• Location of the fracture
  If the fracture involves the cartilage of the wrist joint, then surgery may be more likely. While bone can remold over time, the cartilage surface of the wrist joint cannot. If the cartilage surfaces are not lined up sufficiently with a reduction (resetting) maneuver, then surgery may be considered.
• Displacement of the fracture
  If the bones are severely misaligned, then surgery may be performed to properly position the fragments. This is usually attempted without surgery, but it is possible for muscle and tendon to become entrapped and block the resetting. Furthermore, some fractures may be unstable and not stay in position even with a well fit cast. These may need surgery to adequately position the fracture.
• Adequacy of non-surgical management
  If a fracture is displaced, usually the patient will have an attempted reducti