Wrist Fracture

Wrist Fracture Treated With Immobilization

A wrist fracture is a break or crack in one of the bones of your wrist. Your wrist is made of eight small bones at the palm of your hand (carpal bones) and two long bones that make your forearm (radiusand ulna).

A wrist fracture is often treated by wearing a cast, splint, or sling (immobilization). This holds the broken pieces in place so they can heal.

Follow these instructions at home:

If you have a splint:

• Wear the splint as told by your doctor. Remove it only as told by your doctor.
• Loosen the splint if your fingers tingle, get numb, or turn cold and blue.
• Do notlet your splint get wet if it is not waterproof.
• Keep the splint clean.

If you have a sling:

• Wear it as told by your doctor. Remove it only as told by your doctor.

If you have a cast:

• Do notstick anything inside the cast to scratch your skin.
• Check the skin around the cast every day. Tell your doctor about any concerns. You may put lotion on dry skin around the edges of the cast. Do notput lotion on the skin underneath the cast.
• Do notlet your cast get wet if it is not waterproof.
• Keep the cast clean.

Bathing

• Do nottake baths, swim, or use a hot tub until your doctor says that you can. Ask your doctor if you can take showers. You may only be allowed to take sponge baths.
• If your cast or splint is not waterproof, cover it with a watertight plastic bag while you take a bath or a shower. Do notlet the cast or splint get wet.
• If you have a sling, remove it for bathing only if your doctor says this is okay.

Managing pain, stiffness, and swelling

• If directed, put ice on the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Driving

• Do notdrive or use heavy machinery while taking prescription pain medicine.
• Ask your doctor when it is safe to drive if you have a cast, splint, or sling on your wrist.

Activity

• Return to your normal activities as told by your doctor. Ask your doctor what activities are safe for you.
• Do range-of-motion exercises only as told by your doctor.

General instructions

• Do notput pressure on any part of the cast or splint until it is fully hardened. This may take many hours.
• Do notuse any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your doctor.
• Take over-the-counter and prescription medicines only as told by your doctor.
• Keep all follow-up visits as told by your doctor. This is important.

Contact a doctor if:

• Your cast, splint, or sling is damaged or loose.
• You have any new pain, swelling, or bruising.
• Your pain, swelling, and bruising do not get better.
• You have a fever.
• You have chills.

Get help right away if:

• Your skin or fingers on your injured arm turn blue or gray.
• Your arm feels cold or gets numb.
• You have very bad pain in your injured wrist.

Wrist Fracture Treated With ORIF

A wrist fracture is a break or crack in one of the bones of your wrist. Your wrist is made up of eight small bones at the palm of your hand (carpal bones) and two long bones that make up your forearm (radiusand ulna).

If your fracture is displaced, that means that one or more parts of a bone have been moved out of normal position and the normal alignment between bones is destroyed. This type of fracture is treated with a surgical procedure that is called open reduction with internal fixation (ORIF). In this procedure, the bone pieces are put back together, and they are held in place by plates, screws, or other types of hardware. The procedure helps the bones to heal properly.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other structures or organs.

What happens before the procedure?

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
• Plan to have someone take you home after the procedure.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• The surgeon will make an incision through your skin to expose the areas of the fracture.
• The broken bones will be returned to their normal positions. To hold the bones in place, the surgeon will use screws and a metal plate or different types of wiring.
• The surgeon will close the incision with stitches (sutures) or staples.
• A bandage (dressing) will be placed over your incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You will be given medicine as needed for pain.
• Do notdrive for 24 hours if you received a sedative.
• You may have physical therapy while you are in the hospital.

Wrist Fracture Treated With ORIF, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Swelling.
• Stiffness.

Follow these instructions at home:

If you have a splint:

• Wear the splint as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the splint if your fingers tingle, become numb, or turn cold and blue.
• Do notlet your splint get wet if it is not waterproof.
• Keep the splint clean.

If you have a sling:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.

If you have a cast:

• Do notstick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Report any concerns to your health care provider. You may put lotion on dry skin around the edges of the cast. Do notapply lotion to the skin underneath the cast.
• Do notlet your cast get wet if it is not waterproof.
• Keep the cast clean.

Bathing

• Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• If your cast or splint is not waterproof, cover it with a watertight plastic bag when you take a bath or a shower.
• Keep the bandage (dressing) dry until your health care provider says it can be removed.
• If you have a sling, remove it for bathing only if your health care provider tells you that it is safe to do that.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Managing pain, stiffness, and swelling

• If directed , apply ice to the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Driving

• Do notdrive or operate heavy machinery while taking prescription pain medicine.
• Do notdrive for 24 hours if you received a sedative.
• Ask your health care provider when it is safe to drive if you have a cast, splint, or sling on your wrist.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Do notput pressure on any part of the cast or splint until it is fully hardened. This may take several hours.
• Do notuse any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your cast, splint, or sling is damaged or loose.
• Your pain is not controlled with medicine.
• You develop a rash.
• You have more redness, swelling, or pain around your incision.
• Your incision feels warm to the touch.
• You have more fluid or blood coming from incision.
• You have a fever.

Get help right away if:

• Your skin or fingers on your injured arm turn blue or gray.
• Your arm feels cold or numb.
• You have severe pain in your injured wrist.
• You have pus or a bad smell coming from your incision.
• You have trouble breathing.
• You feel faint or light-headed.

Wrist Fracture Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse.  Do notbegin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your wrist and hand. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Wrist flexion, active-assisted

1. Extend your left / right arm in front of you, and point your fingers downward.
2. If told by your health care provider, bend your left / right arm.
3. Gently bring the palm of your hand toward your forearm until you cannot go any farther.
4. If told by your health care provider, help bring your palm farther by using your other hand. You should feel a gentle stretch on the top of your forearm and wrist.
5. Hold this position for __________ seconds.
6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Wrist extension, active-assisted

1. Extend your left / right arm in front of you, and turn your palm upward.
2. If told by your health care provider, bend your left / right arm.
3. Bring your palm and fingertips back so your fingers point downward. Go as far as you can without pain.
4. If told by your health care provider, help bring your hand farther by using your other hand. You should feel a gentle stretch on the back side of your forearm and wrist.
5. Hold this position for __________ seconds.
6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Ulnar deviation

1. Start with your arm supported at your side or on a table.
2. Move your left / right wrist and hand so your pinkie travels toward your forearm and your thumb moves away from your forearm.
3. Hold this position for __________ seconds.
4. Slowly return your wrist to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Radial deviation

1. Start with your arm supported at your side or on a table.
2. Move your left / right wrist and hand so your thumb moves toward your forearm.
3. Hold this position for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Finger mobility

1. Start with your elbow and forearm supported.
2. Straighten your fingers as much as you can so your hand is flat.
3. Hold this position for _________ seconds.
4. Bend your fingers to make a gentle fist with your hand.
5. Hold this position for _________ seconds.
6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your wrist. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise F: Grip

1. Hold one of these items in your left / right hand: a tennis ball, a dense sponge, or a large, rolled sock.
2. Squeeze as hard as you can without increasing any pain. If told by your health care provider, push just one fingertip into the ball at a time.
3. Hold this position for __________ seconds.
4. Slowly release your grip.

Repeat __________ times. Complete this exercise __________ times a day.