Breaks in the bones in the forearm (radius, ulna) near the wrist are considered to be wrist breaks. During the corresponding surgical treatment, the break is straightened and stabilised with an angle plate or fixed with an external fixation device.
Wrist breaks are those which occur in the forearm bones (medical terms: radius, ulna) near the wrist. Around 25 per cent of all the fractures which occur in adult patients are fractures of the radius bone (also termed distal radius fractures), near the wrist joint. Thus, it is by far the most comment type of bone break. A radius fracture typically occurs when people try to catch themselves with their hand during a fall and their entire weight lands on their wrist.
Uncomplicated wrist breaks, i.e. those where the break is not displaced and the wrist is unaffected can be conservatively treated. However, if the wrist is impacted by the fracture, the break is displaced or any of the soft tissues are injured, the patient will require surgery. In this case, [osteosynthesis procedures] with metal plates, screws or wires come into play. Forearm breaks which do not involve the wrist are explained in the chapter entitled [Surgery on forearm fractures].
What preparations are carried out before the procedure?
The location and progression of the wrist break are determined with an x-ray examination. If the patient has addition injuries to the wrist bones, a CT or an MRI is carried out.
All the usual pre-operative assessments are required, such as a blood test, blood pressure measurement and an ECG. The patient must stop taking blood-thinning medication and should have an empty stomach for the procedure.
How is the operation performed?
Depending on the situation and the general condition of the patient, the operation is performed under general or regional anaesthesia. If a regional anaesthesia is used, the patients receive a sedative and usually sleep during the operation.
The procedure and the material used to fix the break depends on where it is located and the type of forearm break. Nowadays, broken wrists are usually treated with a plate osteosynthesis. This involves using an angle joint plate to fix the hand in an anatomically correct, slightly angled position. The broken bones are exposed for the operation. The break is straightened and the angle plate is fixed on both sides of the break line. If carpal bones are fractured, these are also straightened and fixed with screws or wires.
Fixation with an external device is preferred over plate osteosynthesis for older patients with fractures outside the joint surface. In the process, the break is secured with a metal frame which is attached externally. This method is gentler on the soft tissue.
What is the success rate of this procedure?
The type of fracture, the condition of the bone and the general condition of the patient will influence the healing process. Broken wrists usually heal well after surgery. The wrist must be secured in an anatomically correct position if the operation is to be a success.
What are the possible complications and risks of this procedure?
Surgery on broken wrists is usually risk-free. As with all surgery, in exceptional cases the operation may lead to infections, nerve damage, post-operative haemorrhaging or blood clots. In rare cases, it can lead to joint stiffness, incorrect healing and osteoarthritis. Or a regional pain syndrome, Morbus Sudeck, can develop. Bone growth can be impaired in children.
What happens after the operation?
Depending on the procedure used, the operation can be performed in an outpatient clinic. However, it sometimes requires a few days in hospital. Exercises are begun early so that the patient retains movement in the joints and fingers. After treating the break with an angle plate, the hand is immobilised with a splint for 2 to 3 days. After the splint is removed, the hand can generally be moved without any pain. "External fixation devices" and wires are removed in 6 weeks. The angle plate is usually left in the body as long as it does not cause any complaints.
In severe cases, i.e. complete destruction of the wrist or severe osteoarthritis of the wrist, an artificial wrist (wrist prosthesis) can be used. However, the related indication is given cautiously as full wrist function cannot be achieved with a prosthesis either.