1. Diagnosis
If the injury is not that painful and the wrist is not deformed, you can splint, ice and elevate the wrist while you wait to see the doctor the next day. But if it is very painful, or the wrist looks deformed, or the fingers turn color, then you should go to the emergency room.
2. Radiographs
A doctor will take an X-ray of the wrist to diagnose the fracture and prescribe treatment. Sometimes, if the fracture is intra-articular or extremely comminuted (pulverized), a CT scan may be ordered. Rarely is an MRI necessary.
3. Nonsurgical Treatment
If the alignment of your broken bones is good, then you may be able to wear a cast to keep the wrist in place while the bone heals. Otherwise, the bones need to be realigned ("reduced"). If this can be done without opening the skin, it is called a closed reduction. After alignment, a splint is used for the first days to allow for some swelling. After the swelling goes down, a cast is applied. Otherwise, swelling inside a cast can cause pressure to build up in the arm and potentially cut off the blood supply to the hand. As the swelling goes down further, the cast may be changed so that it is not too loose. Casts are usually worn for about 6 weeks.
4. Surgical Treatment
Sometimes the bones cannot be realigned without opening the skin. This is called an open reduction, which means a trip to the operating room. After the bone is reduced, something is needed to hold those bones in proper alignment until they are healed.
One option is an external fixator, which is a device using pins and crossbars that is outside, or "external," to the skin. The metal pins (stainless steel or titanium) go through the skin to hold the bones. The crossbars hold the pins still. Most external fixators cross the wrist joint, with two pins in the forearm and two pins in the hand bones.
Another option is internal fixation, which is a device that goes directly on the bone and is covered up by the skin. This is usually a plate and screws setup. The plate may go on the volar (palm side) or dorsal (back-of-the-hand side) of the distal radius. These usually stay permanently unless there is a complication with the device, such as an infection. They are made of stainless steel or titanium, and do not usually cause a reaction by the body. The plate does not cross the wrist joint.
5. Physical Therapy
Physical therapy is used after surgery to help regain motion and strength. One advantage of internal fixation is the ability to obtain early range of motion. Because it does not cross the joint, you can move the wrist earlier, whereas in external fixation, you can't. Either way, it is important to move your fingers and the rest of your arm (shoulder, elbow) in a cast or after surgery. Otherwise, you can get stiff in those joints.
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