The wrist is subject to fractures due to falling with outstretched or flexed hand. This can happen in a car, bike, skiing accident or with certain other sports activities. There are two bones in the forearm including the radius and ulna. The radius is on the thumb side. A fracture of the radius near the wrist is called a distal radius fracture.
Splinting is one choice for immobilizing the fracture and is commonly used for wrist fractures, reduced joint dislocations, sprains, soft tissue injury, and post-laceration repairs. Splints are mainly to immobilize and protect the injured wrist, aid in healing and decrease pain. Splints are primarily used for extremity injuries. Good anatomical fracture alignment is important.
There are a variety of splints used to treat fractures of the wrist and forearm. The splint used depends on the location of the fracture. These splints include:
- Volar short arm splint
- Dorsal short arm splint
- Single sugar-tong
- Long arm posterior
- Double sugar-tong
- Long arm
There are two types of distal radius fractures called a Colles or Smith fracture. Determining the break depends on the angle at which the break occurs.
- Colles fracture: results from a direct impact on the palm of the hand; a bump in the wrist results from the distal radius shifting toward the back of the hand.
- Smith fracture is less common and can result from impact to the back of the wrist; a bump in the palm side of the wrist results when the distal radius shifts toward the back of the hand.
Wrist fracture symptoms include:
- immediate pain when area is touched
- bruising and swelling
Treatment for a distal radius fracture is dependent on several factors. For immediate treatment, a splint may be applied to reduce pain and provide some comfort. If the fracture is displaced it is put back into correct alignment under local anesthetic before application of the splint. Additional factors influencing treatment are:
- whether bones have shifted (displaced)
- if there are multiple fractures presentation
- involvement of the joint
- ulnar fracture with injury to median nerve
- whether it is the dominant hand
- occupation and activity level
Once the fracture is in good position, a splint or cast is applied. The splint (or cast) will remain in place for approximately 6 weeks. A removable splint will be worn after that to allow physical therapy to regain proper wrist function and strength. X-rays may be taken at 3 weeks and 6 weeks to assess healing of fractures that were reduced or unstable.
It is still important to be aware of potential complications that require additional monitoring. Complications from immobilization include:
- joint stiffness
- muscle atrophy
- complex regional pain syndrome
The fractured extremity should be immediately evaluated if:
- pain worsens or does not improve after medications
- cast or splint becomes damaged, breaks, or gets wet
- hands/fingers feel numb or cold
- hands/fingers turn blue or white