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Bones of the wrist and hand

A broken wrist or broken hand is a break or crack in one of the many bones within your wrist and hand. The most common of these injuries occurs in the wrist — when people try to catch themselves during a fall and end up landing hard on an outstretched hand.

Risk factors for a broken wrist or broken hand range from participation in certain sports — such as American football, soccer, skiing and snowboarding — to having osteoporosis, a condition in which bones become thinner and more fragile.

It's important to treat a broken wrist or broken hand as soon as possible. Otherwise, the bones may not heal in proper alignment, which can affect your ability to perform everyday activities, such as grasping a pen or buttoning a shirt. Early treatment will also help minimize pain and stiffness.

If you have a broken wrist or broken hand, you may experience these signs and symptoms:

• Severe pain that tends to increase during gripping or squeezing
• Swelling
• Tenderness
• Bruising
• Obvious deformity, such as a bent wrist or crooked finger
• Stiffness or inability to move your finger or thumb
• Numbness or coldness in your finger or thumb

When to call a doctor
If you think you may have a broken wrist or hand, you need to see a doctor immediately — especially if you have numbness, swelling or trouble moving your fingers. Delays in diagnosis and treatment can lead to poor healing, decreased range of motion and decreased grip strength.

Any of the bones in your hands and wrists can be broken by a direct blow or a crushing injury. Common causes include:

• Falls. Falling onto an outstretched hand is one of the most common causes of a broken wrist or broken hand.
• Sports injuries. Many wrist or hand fractures occur during contact sports or sports in which you might fall onto an outstretched hand — such as inline skating or snowboarding. Finger fractures are common with baseball, basketball and football.
• Motor vehicle crashes. High-velocity injuries that can occur during motor vehicle crashes may cause wrist or hand bones to fracture into many pieces, requiring surgical repair.

Participating in certain sports activities or having certain health conditions may increase your chances of experiencing a broken wrist or broken hand.

Sports activities
Many people break bones in their wrists or hands while participating in:

• Basketball
• Football
• Rugby
• Wrestling
• Hockey
• Skiing
• Snowboarding
• Inline skating

Health conditions
You may be more susceptible to broken bones in general if you have:

• Osteoporosis
• Bone disease
• Calcium deficiency

Complications of a broken wrist or broken hand are rare, but they may include:

• Ongoing stiffness, aching or disability. You may experience ongoing stiffness, pain or aching in the affected area even after your broken bone has healed. This generally goes away a month or two after your cast is taken off or after surgery, but you may have some permanent stiffness or aching if your injury was severe. It may also take a few months to regain your ability to use your hand and fingers normally. Be patient with your recovery, and talk to your doctor about exercises that might help.
• Osteoarthritis. Fractures that extend into the joint can cause arthritis years later. If your wrist or hand starts to hurt or swell long after a break, see your doctor for an evaluation.
• Nerve or blood vessel damage. Trauma to the wrist or hand can injure adjacent nerves and blood vessels. Seek immediate attention if you notice any numbness or circulation problems.

You may initially seek treatment for a broken wrist or broken hand in an emergency room or urgent-care clinic. If the pieces of broken bone aren't lined up properly to allow healing with immobilization, you may be referred to a doctor specializing in orthopedic surgery.

What you can do
You may want to write a list that includes:

• Detailed descriptions of your symptoms and how the injury occurred
• Information about past medical problems
• Information about the medical problems of your parents or siblings
• All the medications and dietary supplements you take
• Questions you want to ask the doctor

What to expect from your doctor
Your doctor may ask:

• How did the injury happen?
• Was your wrist or hand bent backward or forward when the impact occurred?
• Are you right-handed or left-handed?
• Where exactly does it hurt, and does any specific movement make it better or worse?

During the physical exam, your doctor will check the affected area for:

• Tenderness
• Swelling
• Deformity
• Open wound
• Nerve damage
• Impaired blood flow

Your doctor may also do some maneuvers to measure your range of motion and grip strength.

Imaging scans are crucial to the diagnosis of a broken wrist or broken hand.

X-rays
Using low levels of radiation, X-rays are a good tool to visualize bone. But X-rays sometimes have problems revealing fractures where the bone is merely cracked. X-rays are painless and take only a few minutes to complete.

Computerized tomography (CT)
CT scans can often uncover wrist or hand fractures that X-rays might miss. Injuries to soft tissues and blood vessels are also easier to see on CT scans. This technology takes X-rays from a variety of angles and combines them to depict cross-sectional slices of your body's internal structures. The test is painless and usually takes less than 20 minutes.

Magnetic resonance imaging (MRI)
MRI uses radio waves and a powerful magnet to produce detailed images of bone and soft tissues. It is much more sensitive than X-rays and can identify very small fractures and ligament injuries. The procedure is painless, but some people feel claustrophobic in the narrow tunnel within the MRI machine.

Bone scan
This technique is good for viewing stress fractures, where a bone is cracked after repetitive trauma. During a bone scan, a small amount of radioactive material is injected into your bloodstream. It collects in the bones, particularly in places where a bone is healing, and is detected by a scanner.

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External fixation of the wrist

If the broken ends of the bone aren't aligned properly, your doctor will need to manipulate the pieces back into their proper positions — a process called fracture reduction. Depending on the amount of pain and swelling you have, you may need a muscle relaxant, a sedative or even a general anesthetic before this procedure.

Immobilization
Restricting the movement of a broken bone in your wrist or hand is critical to proper healing. To do this, you may need a splint or a cast.

Medications
To reduce pain and inflammation, your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). If you're experiencing severe pain, you may need an opioid medication, such as codeine.

Therapy
After your cast or splint is removed, you'll likely need rehabilitation exercises or physical therapy to reduce stiffness and restore movement in your wrist and hand. Rehabilitation can help, but it may take up to several months — or even longer — for complete healing of severe injuries.

Surgical and other procedures
Immobilization heals most broken bones. However, you may need surgery to implant internal fixation devices, such as plates, rods or screws, to maintain proper position of your bones during healing. These internal fixation devices may be necessary if you have the following injuries:

• Multiple fractures
• An unstable or displaced fracture
• Loose bone fragments that could enter a joint
• Damage to the surrounding ligaments
• Fractures that extend into a joint
• A fracture that is the result of a crushing accident

In some cases, the surgeon may immobilize your fracture by using an external fixation device. This consists of a metal frame with two or more pins that go through your skin and into the bone on either side of the fracture.

It's impossible to prevent the unforeseen events that often cause a broken wrist or broken hand. But these basic tips may offer some protection.

Build bone strength
Build strong bones by:

• Eating calcium-rich foods such as milk, yogurt and cheese
• Taking calcium supplements, particularly if you are a woman past menopause
• Getting plenty of weight-bearing exercise, such as brisk walking

Prevent falls. Most broken wrists occur when people fall forward onto an outstretched hand. To prevent this common injury:

• Wear sensible shoes
• Remove home hazards
• Light up your living space
• Install grab bars in your bathroom
• Install handrails on your stairways

Use protective gear for athletic activities
Wear wrist guards for high-risk activities, such as:

• In-line skating
• Snowboarding
• Rugby
• Football