The human wrist is a useful and complicated joint. It can perform strong movements as well as fine intricate ones. It is what is known as a gliding hinge, able to move in different planes.
A wrist fracture, or broken wrist, can cause considerable mobility deficits, heal in abnormal position and alignment, and instigate the onset of arthritis if not treated properly. Treatments for broken wrists can be as varied as the injuries themselves.
Splints are basically supportive braces that immobilize the wrist, but are removable. They can be made of soft materials such as fabric, canvas, leather or types of foam padding. Other splints can be made of the same material that casts are: plaster or fiberglass. Splints can be uniquely created from these materials, or can be available as pre-manufactured splints in various sizes, widths and lengths.
Some splints are made to be slid into place and secured with laces or Velcro straps, while others may require water to activate the materials' hardening process and then are applied with the use of an ace bandage or other wrapping material.
Typically, splints are used in cases where fractures are minimal, non-displaced or as a maintenance device in the later stages of fracture healing.
If the fracture is more complicated or severe than what minimal splinting or wrapping can handle, application of a cast may be required.
A cast is an immobilization device that completely encircles the wrist, hand and forearm. It is typically made of plaster or fiberglass and is rolled onto the wrist over cotton or synthetic padding.
Because a cast is applied with the casting material wet, it allows for a smooth, custom application that will conform to the shapes and curvatures of the hand, wrist and forearm. While wet and pliable, the cast can be molded to form-fit as well as place the wrist in any position desired for maximum fracture immobilization and protection. Once hardened, the cast will not change shape and the position is therefore fixed.
Closed reduction is a procedure that is performed to set the broken bone(s) of the wrist in cases where there is unacceptable position and alignment, displacement, or angulation that is excessive and threatens normal healing and function.
Bone-setting is usually performed by a physician or surgeon with the patient under some kind of sedation or anesthesia. Once the desired position and alignment is restored, it is held in place by using a splint or cast.
Closed Reduction with Pin Fixation
Some wrist fractures can be reduced, or set, rather easily, but are of a nature that is too unstable for the position and alignment to be maintained with a cast or splint. In these instances, some type of assistive internal fixation is required.
One of the easier and more common varieties of the treatment type is the use of smooth, stainless steel pins that are drilled into the bone from outside the body to hold the fragments in place. The pins can then be cut off under the skin, or the tips left protruding for removal in an office setting in a few weeks. This technique is often used with splints and casts for additional protection and immobilization.
In cases where fractures are so severe that there are too many fragments to reasonably restore position, or in cases where surgical violation of the area is not in the patient's best interest, the use of an external fixator is often the method of choice.
The external fixator is a device whose components are kept sterile until the wrist has been surgically scrubbed and draped. Two or more large threaded pins are inserted into the second metacarpal bones of the hand, below the index finger, while another two pins are positioned into the forearm bone called the radius, several inches past the fractured wrist towards the elbow.
The entire procedure is performed with special live X-ray called fluoroscopy, to assure proper hardware placement and alignment of the bone fragments.
Using special clamps, a carbon rod is used to connect the pins and span the wrist without touching or violating the area. After proper and maximum reduction, or setting of the wrist, the clamps are tightened, holding the position. The pin insertion sites are dressed with sterile dressings.
Some broken wrists, frequently in the younger population where maximum and early return to activity is imperative, are treated with a surgical procedure which involves opening the wrist, exposing the fracture, reducing it, and applying a metallic plate onto the bone over the fracture and securing with multiple screws.
The plate can be inserted over the dorsal, back-side of the wrist, or volar, palm-side, depending on the fracture type and type of immobilization needed. The plate is typically not removed after healing and is rarely bothersome when left in place.