Wrist Fracture

Wrist fractures are the most commonly broken bones in the arm. Fractures of the wrist may involve several different bones including the radius and ulna — the two bones of the forearm — as well as the scaphoid, lunate and triquetrum — three smaller carpal bones in the hand.

The most common wrist fracture is a distal radius fracture, when the radius (the larger bone in the forearm) is fractured on the distal end, near the wrist. This often occurs when a child falls on an outstretched hand that is extended backward.

The type of wrist fracture you child sustains will determine its severity, recommended treatment, and how long it will take your child to recover.

Fractures may be described in several different ways:

• Simple fracture (sometimes called a closed fracture): A bone breaks into two pieces but does not break the skin or damage surrounding tissue.
• Complex fracture (also called a compound or open fracture): A bone is broken into several fragments, soft tissues are damaged, and at least part of the bone protrudes through the skin.
• Complete fracture (sometimes called a displaced fracture): A bone is separated into two or more pieces.
• Partial fracture (also called a nondisplaced fracture): A bone is cracked but not broken in two, such as a hairline fracture.
• Intra-articular fracture: A fracture that crosses the surface of a joint and results in some cartilage damage.
• Extra-articular fracture: A fracture that does not extend into the joint.
• Physeal fracture: Childhood fracture that involves the growth plate of a bone.

Complex, displaced and intra-articular fractures near the wrist can be more challenging to treat and require specialized expertise from experienced physicians.

The most common cause of a broken wrist is to fall onto an outstretched arm or to get hit on the wrist. Broken wrists are also common for children who play contact sports, ski, bike and use inline skates.

Symptoms of a distal radius fracture may include:

• Immediate pain
• Tenderness
• Swelling and bruising
• Warmth and redness near the affected area
• Misshapen or crooked appearance, or abnormal position of the hand and wrist
• Difficulty moving the wrist and hand

At Children’s Hospital of Philadelphia (CHOP), diagnosing a distal radius fracture typically begins with a physical examination of your child’s wrist, arm and hand.

In most cases, clinicians will recommend X-rays of your child’s wrist to confirm the diagnosis. X-rays produce images of bones and help doctors identify the type of fracture and extent of your child’s injury.

In addition to a physical exam and X-rays, your child may also undergo:

• Accurate diagnosis helps us determine the best course of treatment for your child.
• Treatment for your child’s wrist fracture will depend on the type of fracture, as well as the age and development of your child.

Nonsurgical treatment

If your child’s distal radius fracture is not too severe and the bone is positioned correctly, the broken wrist will likely be placed in a plaster cast until the bone heals.

For children with a simple, displaced fracture — where the bone is not lined up properly — a procedure called a “closed reduction” may be needed to reposition the bone. In this procedure, the bone is straightened without having to open the skin. Clinicians will give your child a local anesthesia to numb the area, and move the wrist fragments into alignment.

Once complete, a splint or cast will be applied to keep the bone in place as it heals. Depending on the complexity of the fracture and how much the area swells after the bone is repositioned, a splint may be used for a few days to allow the swelling to recede before a cast is applied.

Surgical treatment

If your child’s wrist fracture is severe, the bone is broken in multiple places, involves the joint, or the bones cannot be correctly positioned outside the skin, surgery will be necessary.

A pediatric anesthesiologist will give your child anesthesia to keep them from feeling pain and sensation during surgery. A surgeon will make an incision to access the bones in the wrist and move them into better alignment.

To stabilize the fracture and keep the bones in the correct position as they heal, the surgeon may use a cast, metal pins, plate and screws, external fixator or a combination of techniques. Your child’s doctor will discuss the best way to immobilize your child’s wrist as it heals.

Surgical safety

Though surgery for wrist fractures is highly effective, we understand that any surgery can be a stressful experience for children and families. At CHOP, we offer a wealth of resources about how to prepare your child for surgery and what to expect during surgery.

Follow-up care for wrist fractures will depend on the treatment needed. Children with simple distal radius fractures that require a cast will be able to resume regular activities more quickly than those who need surgery.

Children with complex fractures who need surgery will wear a cast or external fixator for six weeks. When the cast or fixator is removed, X-rays are taken to insure your child’s wrist is healing properly.

Once the fracture is stable, your child will be encouraged to begin motion exercises to limit stiffness and regain range of movement. Depending on the complexity of your child’s fracture, physical therapy may also be recommended.

Your child’s doctor will give you specific information about a recovery program for your child and how soon he can return to daily activities.

Wrist fractures are common — but temporary — conditions. Your child may have stiffness in their wrist for up to a year after the injury, but once their wrist has fully healed, there are generally no complications. Long-term follow-up is not necessary and complete recovery is typical.