Kim’s Korner: A Slip of the Wrist

Anyone can slip and suffer injuries trying to break a fall. The force that is transmitted through your arm as you reach out can result in Colles fracture, what we would call a wrist fracture. But it isn’t just falling that can result in this type of fracture; it can also be caused by a car or bike accident or any trauma that places force through the hand.

A Colles fracture is named after Irish surgeon Abraham Colles who, in 1814, before X-rays, identified this fracture based on the obvious deformity that it causes. It is not actually a fracture of the wrist but in fact is a fracture of the radius bone in the forearm. The wrist is made up of eight small bones. The forearm has two: the larger bone, the radius, which sits closer to the wrist bones, and a smaller bone, the ulna, which runs along the outside of the arm, in line with the little finger.

Colles fractures are more common in women than men and occur more often in the young or the elderly. Weaker bones and the presence of osteoporosis may be the cause. People who have poor balance and have been diagnosed with osteoporosis may be advised to wear a wrist guard. However, it only minimizes the risk and does not necessarily prevent all fractures.

A Colles fracture may be obvious immediately, especially if there is pain, swelling, bruising and an obvious deformity. Diagnosing a Colles fracture may be as simple as just looking at the wrist but an X-ray may be required to determine the severity of the fracture. In extreme cases there may be numbness in the area that may indicate there has been damage to the median nerve.

Once diagnosed, the first step is to try to minimize the swelling and the best way to do this is by using ice. It is also important to remember any rings you may be wearing, and to remove them. Swelling may not be immediately obvious but, as the body prepares for action to heal and protect the injury, there will be swelling.

The most important part of the treatment process is to assist the bones in healing in the best way possible. If there is little displacement in the bone, the orthopaedic doctor may perform what is known as a closed reduction. This involves moving the bones back into place without making an incision. Next, it is important to ensure that the bones are not able to move; in most cases this will be as simple as applying a cast to immobilise the bones and allow them to knit back together. This cast will typically stay on for about six weeks.

For people who have a lot of swelling, a strong splint may be used until the swelling reduces. Splints are also used for people who are not overly active and pain is minimal. For example, in the frail or elderly a strong splint will be used instead of a heavy cast.

In cases where there has been a big displacement of the bones, or there are more than two fragments, surgery may be indicated. Depending on the severity of the fracture, the orthopaedic consultant may choose to apply internal fixation such as metal pins, plates or screws, or external fixation that looks like a metal frame around the arm, holding the bones in place. Once the cast, splint or frame is removed after six weeks, then movement is encouraged. At first the wrist will be very stiff and simple movements and tasks will be difficult.

Where recovery is slow and pain still a factor, physiotherapy may be prescribed to help with achieving full function. Treatment will involve a variety of modalities depending on whether you have had surgery or have been treated conservatively, in a cast alone, but may include, electrotherapy for pain; hot wax, stretching, mobilisations and massage for improving the range and, of course, strengthening exercises as, after being immobilised for six weeks, the whole arm may be stiff and weak. The important point to note with this type of fracture is that return to full function can be a long process and can take up to a year; in some cases, it never quite gets back to normal. So, the next time you are dashing around and the floor is wet, take care not to slip.