Wrist and Forearm Fractures

The ulna and radius are the two bones that compose the forearm which connect to the carpal bones in order to form the wrist. The radius and ulna have the ability to turn over one another allowing one’s ability to rotate their forearm.

The ulna is a long bone located at the medial side of the forearm parallel to the radius. The upper end of the ulna has two curved features: the olecranon and the coronoid which attach at the elbow. The lower end contains the head and styloid. The head features an ulnar notch of the radius in the inferior radioulnar joint. The head is separated from the wrist by the articular disc.

The radius is located on the lateral side of the ulna. The upper end of the radius is relatively small and disc-like. It forms only a small part of the elbow-joint. The lower end is large and forms the main component of the wrist-joint.

There are a total of eight carpal bones in the wrist that are all arranged in two rows: distal (further away) and proximal (near to). The scaphoid bone is the largest of the eight carpal bones and crosses both the distal and proximal row.

There are many potential causes of a fracture. Typically, a large and excessive amount of force is required to cause a break in the bone of the forearm, wrist, or any other part of the body. Many broken bones occur in accidents, falls from high altitudes, and sports or recreational activities. In addition, repetitive forces and strains, like running or weightlifting, have been known to cause fractures. These injuries are referred to as stress fractures. Osteoporosis, the disease that causes the degeneration and weakness of bones with age, is another known factor that contributes to fractures. Osteoporosis is very common in the wrist.

The symptoms of a fracture are normally dependent on which bone of the forearm or which bone of the wrist is broken. However, common symptoms of forearm and wrist fractures typically include:

• Severe pain which increases with movement of the affected area
• Severed pain that increases when gripping or squeezing with the hand
• Swelling
• Tenderness
• Bruising
• Deformity
• Inability to turn the arm from palm up to palm down and vice versa

Diagnosing a wrist or forearm fracture usually requires a physical exam followed by imaging tests to determine where the fracture has occurred and its severity. During the physical exam, the attending physician will probe the affected area for tenderness, swelling, bruising, or deformities. The physician may also test range of motion and have the patient move or rotate their wrist or forearm in order to determine the patient’s full extent of dexterity and whether or not there is any pain associated with the movement(s).

After discussing symptoms with the patient, and conversing about how and where the injury occured, imaging tests are often ordered to determine the severity and location of the fracture. XRays are often used to determine the extent of the break, whereas MRIs and CT (CAT) scans provide detailed imaging of any affected tissue.

A fracture is normally treated with a cast or splint. Casts offer hard protection and are wrapped around the affected area and promote the union of the fractured part of the bone. Splints are known to protect only one side of the affected area. Both of these supports maintain the immobilization of the affected area and straighten it.

In some instances, a procedure known as a reduction is given in which the doctor will manipulate the bone pieces back into the correct position. Anesthetics are commonly given prior to this procedure.

Medications including over-the-counter pain relievers, antibiotics, and opioid medications are given depending on the severity of the break or whether or not the fracture is diagnosed as a compound fracture.

Surgery is occasionally required in order to stabilize some fractures. If the fracture is not compound, the surgeon will often wait to proceed until the swelling of the affected area has gone down.

Rehabilitation is often the next course of action after treatment. Physical therapy increases the strength of the muscles, tendons, and ligaments that surround the bone. Therapy also helps by encouraging motion in the arm to alleviate any stiffness and return the affected area to its full range of motion. Progress is often monitored through routine XRays, MRIs, or CT (CAT) scans.