Every wrist fracture is unique in terms of the extent of fracturing and the degree of displacement. Simple non displaced fractures can usually be managed in a plaster. For displaced fractures, internal fixation may be required.
Currently most fractures are fixed through an incision on the front of the wrist (palm side). Wrist fixation surgery is performed under general anaesthetic. A tourniquet is applied the arm to stop any bleeding.
An incision is made on the front of the wrist. The tendons are moved to the side. The muscle overlying the distal end of the radius is elevated off the bone and this allows exposure of the distal radius.
In simple fractures which do not involve the articular surface, the fracture is reduced into position and a plate is applied. These plates are pre-contoured to fit the average distal radius. Screws are inserted through the plate into the bone. The screw heads have a thread which locks into the plate to give a very stable fixation pattern.
Once the fracture has been reduced and plated, the final position is checked on x-ray in theatre. The wounds are then closed.
A large volume of local anaesthetic is injected to ensure that the patient is comfortable in the post-operative phase.
The wrist is placed in a plaster of paris splint to provide support.
Most patients stay in hospital for one night after wrist fixation surgery with their arm elevated. This also allows patients to receive extra pain relief if needed.
With stable fixed fractures, patients can start working on their range of movement from an early stage. Often patients are referred to hand therapists to have a lightweight removable splint made. This can be removed several times a day to allow range of movement exercises.
Patient are reviewed at the two-week stage for removal of the sutures and repeat x-rays are performed at six weeks to assess how the fracture is healing.
In cases of more significant fracturing, the extent of the surgery will vary depending on how many fragments have been created in the injury. Often additional plates will be required to provide stability. Occasionally a second incision on the back of the wrist will be required to allow reduction of the fragments and possibly insert a plate on that surface also.
Many patients will fracture the tip of the ulna in association with their radius fracture. In most cases this fracture fragment does not require fixation.
Recovery after a wrist fracture will depend on the extent of the initial fracturing and also the degree of swelling the patient develops in the post-operative phase.
The aim of surgery is to reduce the articular surface back to an anatomical position so that the patient can regain the range of movement and also to reduce the risk of further degenerative changes in the wrist. Any fracture that extends into the joint surface will cause damage to the cartilage on the joint surface.
As with all surgery, there is a risk of infection. Antibiotics are given at the time of surgery to reduce the chance of infection developing.
There is a risk of irritation of the nerves at the front of the wrist. Patients with previous carpal tunnel syndrome will often find that the symptoms are worse after a wrist injury and in some instances, a carpal tunnel decompression may be required at the time of wrist fixation.