Wrist and Hand Fractures

Risk Factors for Hand and Wrist Fractures

Wrist and hand fractures are a significant health concern in the United States, with more than 450,000 cases annually. Distal radius fractures alone make up about one-sixth of all fractures seen in emergency departments. These injuries are particularly prevalent among the elderly due to conditions like osteopenia and osteoporosis and naturally decreasing bone density with age, often leading to fractures from minor falls. These conditions make their bones more fragile and prone to breaking under less forceful impacts, such as falls.

Women are more susceptible due to decreased bone mineral density, early menopause, and a family history of fractures.

In younger individuals, wrist fractures are typically the result of high-energy traumas from activities like skiing or contact sports.

Our physical therapy experts focus on rehabilitation techniques to improve bone health, minimize future injury risk, and support a smooth recovery. If you or a loved one are facing a wrist or hand fracture, reach out to us to learn how our personalized care can help.

Clinical Evaluation: History and Physical Examination

Understanding wrist fractures begins with a thorough clinical evaluation, focusing on the injury’s history and physical examination. By exploring the mechanism of trauma, healthcare providers can glean important insights into the fracture’s severity and type. If you’re experiencing wrist pain, swelling, or a limited range of motion, these symptoms are key indicators during diagnosis.

In more severe cases, such as comminuted (when the bone shatters) or open fractures (when there is a break in the skin), the evaluation process extends to identifying potential complications like instability or infection risks due to bone exposure. It’s crucial to perform neurological and vascular assessments. This helps in identifying issues such as nerve damage or compromised blood circulation that may require immediate attention.

Your overall health status—especially conditions like osteoporosis—also plays a significant role. Such factors can influence both fracture healing and the choice of treatment. Remember, every fracture is unique, and a comprehensive evaluation is the first step towards an effective recovery plan. If you have concerns about your wrist injury, seek guidance from a health care provider who can customize a treatment plan for your specific needs.

Diagnostic Imaging Techniques

Accurate diagnosis is essential for managing wrist and hand fractures effectively. By utilizing advanced imaging techniques, healthcare providers can determine the specific type and nature of the fracture. This understanding is crucial for developing an effective treatment plan tailored to the patient’s unique needs. When it comes to wrists and hands, imaging plays a vital role in visualizing the extent of the injury.

X-rays

X-rays remain the go-to method for diagnosing wrist fractures. They provide a clear image of the affected area, helping to identify whether the fracture is stable or displaced. However, some stress fractures may elude immediate detection on an X-ray, requiring additional time or other imaging methods to become apparent. For more complex, high-energy fractures, a CT scan can accompany X-rays to offer a comprehensive view of the fracture pattern.

MRI Scans

In cases where a scaphoid fracture is suspected but X-ray results are inconclusive, MRI scans are invaluable. This method is particularly effective for identifying fractures that may not be initially visible, offering a more detailed assessment. If there’s a strong indication of a fracture from a physical examination.

CT Scans

Computed tomography (CT) scans are occasionally required to fully understand joint fractures that X-rays might not reveal clearly. By combining X-rays with computer technology, CT scans produce detailed, three-dimensional images of the injury. Such comprehensive visualization is especially crucial for complex fractures or ones involving the wrist joint, as it guides treatment planning and potential interventions like realignment or surgery.

Treatment Management Strategies

Initially, you may consult with an emergency department physician who will assess the fracture’s severity. Depending on the evaluation, you could be referred to an orthopedic or hand surgeon for specialized care. Treatment strategies can vary substantially based on the type and severity of the fracture. While some fractures can heal effectively with non-surgical methods, others might necessitate surgical intervention.

Non-surgical Options

For less severe wrist fractures, non-surgical treatments are often recommended. This approach typically involves closed reduction, where doctors realign the fractured bones without making surgical incisions. Following realignment, a splint, like a volar or sugar tong splint, is applied to stabilize the wrist. Immobilization usually lasts about 6 to 8 weeks, and progressive strengthening exercises begin thereafter, with a return to full activity by 10 to 12 weeks post-injury.

Surgical Interventions

Severe wrist fractures or those that fail to heal satisfactorily with conservative care may require surgical intervention. Open reduction and internal fixation (ORIF) is a common procedure involving the use of plates and screws to secure the bone properly. Certain fractures, such as scaphoid fractures, may necessitate surgery if they show poor healing, often due to inadequate blood supply. In complex cases, a bone graft might be used to fill significant gaps after bone realignment, promoting healing.

Rehabilitation Protocols

Rehabilitation for wrist and hand fractures is an important part of recovery. Often, after sustaining a fracture, patients will wear a cast or splint for about five to six weeks. This stabilization is essential for allowing the bone fragments to heal properly. Once the cast is removed, physical therapy becomes key in restoring strength and range of motion.

Once you begin physical therapy, our trained professionals will guide you through exercises tailored to your specific needs and type of fracture. These exercises are designed to improve flexibility and prevent stiffness.

Throughout recovery, it’s important to keep your fingers moving to maintain mobility. Hand therapy can be especially beneficial in regaining motion and strength. While recovery times vary, and some stiffness might linger, our team is here to support you every step of the way. Remember, healing takes time, but with physical therapy, you can actively engage in your recovery process and expediting your return to everyday activities. If you have any questions or concerns, don’t hesitate to reach out to one of our local clinics for a consult.

Preventive Measures for Wrist and Hand Injuries

To decrease the risk of falls, it’s important to create a safer home environment. Wear sensible shoes and remove tripping hazards such as throw rugs and extension cords. Installing grab bars in bathrooms and handrails on stairways can provide additional safety and help prevent falls that may lead to wrist injuries.

Additionally, avoiding slippery surfaces, especially those covered in snow or ice, can significantly reduce fall risks and related wrist fractures. When engaging in high-risk activities like in-line skating, snowboarding, rugby, and football, wearing protective gear such as wrist guards is highly recommended to safeguard against injuries.

Taking these preventive measures can help you maintain strong and healthy wrists, reducing the likelihood of fractures and ensuring you can continue enjoying your favorite activities.

When to Seek Medical Attention

While many wrist and hand fractures heal well with conservative treatment strategies, it’s important to remain vigilant. If you experience any of the following, consult a healthcare professional for a physical exam:

• Increased, persistent or severe pain that does not improve with rest and rehabilitation.
• Signs of infection, such as increased redness, swelling, or discharge at the injury site.
• Any loss of sensation or drastic changes in blood flow to the fingers, indicating a possible complication.
• Loss of motion or difficulty in performing daily tasks even after the expected recovery period.

Physical therapy is an essential component of recovery. Here are some key indicators that signal the appropriate timing for starting physical therapy:

Immediately Post-Cast or Splint

Once your cast or splint is removed, physical therapy should ideally begin. This is critical as muscles and tissues can become stiff and weak during immobilization. A physical therapist will design a personalized rehabilitation program focusing on restoring strength, flexibility, and range of motion lost during immobilization.

During the Healing Process

In some cases, your doctor may recommend beginning gentle physical therapy while still in the cast to address stiffness and maintain some level of muscle activity. This will depend on your fracture type and the healing stage. Your physical therapist may use specific techniques to promote circulation and prevent stiffness.

Addressing Pain and Swelling

If you experience significant pain, swelling, or discomfort post-injury, this may indicate a need for physical therapy intervention. A trained therapist can perform hands-on techniques to reduce swelling and alleviate pain through modalities like ultrasound, ice therapy, or electrical stimulation.

As Mobility Increases

As your fracture heals, you will gradually regain movement in both your wrist and hand. It’s essential to work with your physical therapist to safely progress through the rehabilitation stages. Here’s what to expect as mobility improves:

Restoring Range of Motion

Initially, your therapist will focus on restoring your range of motion (ROM). This often involves gentle stretching exercises to help loosen stiff joints and tissues. It is crucial to perform these exercises as prescribed, even if there’s some discomfort. They help to break down scar tissue, improve flexibility, and ensure that your wrist and fingers can move freely once again so you can return to normal activity levels.

Strengthening Exercises

After achieving a satisfactory range of motion, the focus will shift to strengthening exercises. These will usually start with simple movements, gradually advancing to more challenging tasks as your strength improves. Building strength is vital for regaining function, allowing you to perform daily activities, such as gripping, lifting, and fine motor tasks.

Functional Activities

In addition to specific exercises, your rehabilitation will include functional activities that mimic daily tasks. This could involve practicing grip strength by using therapy putty or completing specific motions relevant to your everyday life. These activities help bridge the gap between clinical exercises and real-world applications, enhancing your confidence and encouraging a sense of normalcy in your recovery process.

Incorporating Home Exercises

To maximize recovery after a broken bone, your therapist will likely give you a series of exercises to perform at home. These will complement your in-clinic sessions and promote continuous improvement. Here are some examples of home exercises you might perform:

1. Finger Flexion and Extension

This exercise helps to restore mobility and strength in your fingers. Begin by placing your hand flat on a table or other hard surface. Slowly lift each finger one at a time off the surface while keeping the others flat. After lifting your fingers, gently lower them back down. Aim for 10 repetitions for each finger, and then focus on extending all fingers simultaneously.

2. Wrist Circles

Wrist circles are essential for improving mobility in the wrist joint. Hold your arm out in front of you with your elbow straight. Slowly rotate your wrist in a circular motion, completing 10 circles in one direction before reversing and doing another 10 in the opposite direction. Keep the movements gentle to avoid straining the healing tissues.

3. The Towel Squeeze

To strengthen your grip, take a small towel and roll it up. Grasp the rolled towel in your hand and squeeze it tightly for about five seconds, then relax. Repeat

the exercise for 10-15 repetitions. This exercise not only enhances grip strength but also engages the muscles in your forearm, which are crucial for overall hand functionality. Over time, you can increase the resistance by using a thicker towel or a stress ball.

While engaging in these exercises, it’s essential to monitor your progress and consult your therapist regularly. They may provide feedback and adjust your rehabilitation plan based on your recovery. Keeping a journal of your exercises, noting any pain levels or improvements in mobility, can be a helpful tool during recovery.

Gradual Return to Normal Activities

As you progress through your rehabilitation, the goal is to prepare you for a smooth transition back into your daily routine. Here are some functional activities that may be included in your therapy:

• Adaptive Techniques: If certain movements are painful or uncomfortable, your therapist may teach you adaptive techniques. For instance, using larger handles on utensils or grips can minimize strain and make tasks easier.
• Simulated Daily Tasks: Your therapist might set up scenarios where you practice common activities. These exercises not only improve strength but also allow you to test your coordination and endurance.
• Task-Specific Training: If you have specific hobbies or work tasks involving your hands, your therapist can customize your rehabilitation plan. This ensures that you’re practicing skills that are particularly relevant to your lifestyle.