From Jonathan Cluett, M.D.,
Your Guide to Orthopedics.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

A broken wrist is among the most common broken bones. In fact, wrist fractures are the most commonly broken bone in patients under 65 years of age (after that age, hip fractures become the most common broken bone).

Usually, when a doctor i describing a wrist fracture, he or she is referring to a fracture of the radius (one of two forearm bones). There are other types of broken bones that occur near the wrist, but a 'wrist fracture' generally means the end of the forearm bone has been broken.

How is the diagnosis of a wrist fracture made?
A wrist fracture should be suspected when a patient injures their wrist joint and has pain in this area. Common symptoms of a wrist fracture include:

• Wrist pain
• Swelling
• Deformity of the wrist

When a patient comes to the emergency room with wrist pain, and evidence of a possibly broken wrist, the first step is to obtain x-rays of the injured area. If there is a broken wrist, the x-rays will be carefully reviewed to determine if the fracture is in proper position, and to assess the stability of the bone fragments.

What is the usual treatment for a wrist fracture?
Most often, broken wrists can be treated in a cast. The wrist is one area of your body that is very amenable to cast treatment. If the bones are out of proper position, then some light sedation or local anesthesia may be used so your doctor can reset the fracture. This is called 'reducing' a wrist fracture, and by performing specific maneuvers, your doctor may be able to realign the broken wrist.

Which wrist fractures need surgery for treatment?
This is a difficult question to answer, and must be addressed on a case by case basis. Even on an individual basis, orthopedists may differ on their opinion of optimal treatment for a given fracture.

Some of the following are important considerations in determining whether or not surgery is necessary for a broken wrist:

• Age and physical demands of the patient
  If a patient is young and active, every effort will be made to restore the wrist to normal. In some wrist fractures, this may help prevent problems in the years ahead. However, if the patient does not require heavy demands of the wrist, or if the patient is elderly, perfect restoration of the broken bones may not be necessary.

• Bone quality
  If the bone is severely osteoporotic, then surgery may be less beneficial. If plates and screws are used to fix a fracture, the bone quality must be adequate to secure the screws. Surgery is traumatic to the bone, and sometimes the best course of action is to minimize further insult to the bone and treat in a cast.

• Location of the fracture
  If the fracture involves the cartilage of the wrist joint, then surgery may be more likely. While bone can remold over time, the cartilage surface of the wrist joint cannot. If the cartilage surfaces are not lined up sufficiently with a reduction (resetting) maneuver, then surgery may be considered.

• Displacement of the fracture
  If the bones are severely misaligned, then surgery may be performed to properly position the fragments. This is usually attempted without surgery, but it is possible for muscle and tendon to become entrapped and block the resetting. Furthermore, some fractures may be unstable and not stay in position even with a well fit cast. These may need surgery to adequately position the fracture.

• Adequacy of non-surgical management
  If a fracture is displaced, usually the patient will have an attempted reduction, or repositioning of the broken bone. Sometimes it is difficult to reposition the bones without surgery. Other times, the positioning is satisfactory, but casting may not hold the fracture in that position. Surgery can usually be performed any time in the first two weeks after a fracture to restore the bones to their proper position.

As stated earlier, surgery is not usually needed for a wrist fracture, but it may be considered in some situations. If surgery is performed, there are several options for treatment. Some fractures may be secured with pins to hold the fragments in place. Another option is an external fixator, a device that uses pins through the skin and a device outside the skin to pull the fragments into position. Finally, plates and screws may be used to position the fracture properly.