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All in the wrist

Nurturing

SLIP SLIDING AWAY Icy paths and fallen leaves make this time of year treacherous for falls.

Health

Andrew O'Brien

’Tis the season. Not that season, though. Who knows what’s going on with that season? No, it seems to be the season for wrist fractures.
Having barely heard mention of a broken wrist for what seems like years, a ‘handful’ appear at the same time. Hardly surprising though, given that wrist fractures reportedly account for one-sixth of all fractures treated in emergency departments.
Most wrist fractures involve injuries of the radius, the forearm bone on the ‘thumb-side’ of your arm. This is because it is the main weightbearing bone in your forearm and, given that wrist fractures are typically the result of a fall, the radius generally takes the impact. It seems there are two distinct types of falls that lead to fractures, depending on age and gender.
In the under 40 age group, the patients are more likely to be male and any injury tends to be high impact; think falling off a bike or a trampoline, playing sport or car accident. Over the age of 40, the patient is more likely to be female, and the injury lower impact – often the result of a simple fall. This is most likely due to reduced bone density, and in the days before routine Dexa scans was often the first sign of osteoporosis.
The most common type of wrist fracture is the Colles’ fracture, where the radius is displaced dorsally, or backwards. Like all good things in this world, there is an Irish link here; Abraham Colles was Professor of Anatomy, Surgery and Physiology at the Royal College of Surgeons in Ireland. Colles described the fracture of radius in 1814, long before the advent of X-rays.
A Colles’ fracture that doesn’t displace too far doesn’t usually need surgery, and can be placed in a plaster cast for six weeks. A fracture with more that 20 degrees of deviation usually requires surgery, and there are a multitude of options here, from external wires and frames to the most common plate and screws. It might seem counter-intuitive, but the wrist that has had surgery can often start rehab earlier than the one that has been managed conservatively. This is because the bones have been stabilised by plates and screws, so any braces or splints can be removed earlier.
Rehabilitation after a fractured wrist can be a slow process. In the early stages the main aim is to get moving as quickly as possible and build strength gradually. Range of movement tends to improve relatively quickly in the first three months before progress slows. Patients often take 12 months to achieve full range of movement. If you think that’s slow, it’s worth considering that strength typically takes longer again to fully recover, with patients often complaining of weakness in weight-bearing movements like pushing up from a chair for more than a year.
There are, of course, various possible complications along the road to full recovery. The two most common of these are non-union or malunion, where the bone either fails to heal or heals with poor alignment, and complex regional pain syndrome. In cases of non-union or malunion, surgery is often required to correct the alignment or to introduce bone grafts to encourage healing.
Complex regional pain syndrome is, as the name suggests, a complex problem where the symptoms experienced appear to be more severe than would be expected. The hand is often swollen, stiff and hypersensitive to different stimuli such as light touch. Patients may notice symptoms like shiny, clammy skin or excessive sweating of the hand. This type of response is more common in women who have had surgery and tends to require multidisciplinary input due to the long-term physical and psychological impact it can have.
Why worry about wrist fractures now? Given that winter and Christmas are both on the doorstep, remember what causes wrist fractures: falls. Be wary if it’s icy or slippery under foot when you’re out and about. And if Santa is bringing the kids a skateboard, maybe mum dad should bring wrist guards.

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.