Fracture to the Wrist from falling on an outstretched hand
With the freezing cold weather that we had last week and the associated high risk of falling on the icy footpaths, I will base this week’s article on Wrist fractures. When we fall on an icy surface we stretch out our hand to protect ourselves from a more severe trauma to our shoulders or knees. However, this causes severe trauma of the wrist joint and commonly results in a wrist fracture called a Colles’ Fracture. A Colles’ fracture is particularly common amongst older people after a fall onto an outstretched hand. It can affect young athletes also as a result of a fall during a game.
The fracture affects the end of the radius bone of the wrist joint. The radius bone alongside the ulna bone is the 2 bones of the forearm that helps in forming the wrist joint (See illustration). Indeed, a Colles’ fracture can often involve a fracture to the end of the ulna bone at the wrist joint.
Signs & Symptoms
Immediate pain into the wrist
Visible swelling and tenderness of the wrist are present
Touching the wrist causes sharp pain
Nerve pain may be present due to the compression on the medial & ulnar nerve
The wrist gives an appearance that a bone has been displaced backwards on the back of the wrist; this is the ‘Dinner Fork’ appearance.
Complications that can occur after the removal of the cast after a Colles’ fracture include:
Reflex Sympathetic Dystrophy which causes swelling joint capsule tightness & stiffness into the hand, elbow and even the shoulder.
Carpal Tunnel syndrome causing nerve pain into the hand.
Rupture of the Extensor Pollicis Longus muscle that extends the thumb & wrist
Poor re-alignment of the fractured bones in the cast, hence the importance & of a follow-up x-ray.
An x-ray should be carried to reveal if a Colles’ fracture is present.
A cast is applied to the wrist for 4-6 weeks duration to allow the fracture to heal.
Once the cast is removed, it is important that exercises are put in place to re-establish true joint movement of the wrist. Graded Mobilisation treatment to wrist joints is very important in helping to attain full wrist movement. Exercises to help build the strength into the hand, fingers, forearm and shoulder are essential also.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles.
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