Fracture repair

Wrist fracture is full or partial breakage of the wrist bone.  One of the most common broken bone injuries, wrist fractures represent approximately 16 percent of all fractures seen in the emergency room. The treatment that may be right for your wrist fracture depends on a variety of factors including age, past and current health, the severity of the breakage and any past reactions to various treatments or medications.

Types

There are many different types of fractures. The specific type of fracture repair treatment is based upon the severity and type of fracture affecting the bone and includes:

  • Stable fracture – In this type of fracture, the broken bones remain aligned, which usually means the bones will stay together during the healing process.
  • Displaced fracture – The broken ends of the bones are not aligned, and surgery is usually required to realign the bones in the correct position.
  • Open fracture – Also known as a compound fracture, this break causes the bones to shift and break out through the skin. The surrounding muscle, ligaments and tendons often are damaged during this type of injury.
  • Closed fracture – The bones do not break through the skin but can still damage the surrounding tissue.
  • Comminuted fracture – The broken bone shatters into three or more pieces.
  • Transverse fracture – The fracture is at a right angle to the long axis of the bone.
  • Greenstick fracture – A fracture that occurs on one side of the bone can cause the other side to bend.

Nonsurgical treatment

If the fracture is stable or does not require surgery, then your doctor will recommend one or more of the following nonsurgical fracture repair treatments:

  • Alignment of the fractured bone – In case of a displaced fracture, the doctor can sometimes set or realign the bone. This can be done sometimes without surgery and is usually followed up with some method for keeping the affected area immobile. In some cases of more severe pain and swelling you will be given a muscle relaxant, sedative or even anesthesia before the procedure.
  • Sling splint or cast – These are designed to immobilize the area containing the fracture to support bone alignment and promote healing.

Surgery

If the fracture causes the bones to go out of alignment and cannot be treated non-surgically, fracture repair surgery will be recommended. Your orthopaedic surgeon will likely perform one of two types of surgery: internal fixation surgery or external fixation surgery:

  • Internal fixation surgery – Your orthopaedic surgeon will begin by making an incision over the area of the fracture. The surrounding ligaments, tendons and nerve bundles will carefully be moved to the side to prevent damage. Any loose bone fragments will be removed along with any damaged cartilage covering the bone. Your surgeon will then realign the fractured bones and any other misaligned bones. Bone cement may be used to reinforce stability in the bones. Bone grafts may also be used to fill in any gaps in the bones created by the loss of bone fragments. Bone graft material is often taken from nearby, healthy bones in your body.

After the bones are properly realigned, your surgeon will use a process known as metal instrumentation to fixate and further support the bone alignment. Screws, plates, pins and wires are used to fixate the bones in position so that they heal in the right position. Once this is done, your surgeon will close the incision with sutures (stitches). After surgery, a cast or splint will most likely be placed over the area of injury to provide further protection while the bones mend back together during the weeks after surgery.

  • External fixation – During this fracture repair surgery, your surgeon inserts pins or screws into the bone above and below the site of the fracture. Your surgeon then realigns the bone fragments and connects the pins or screws to a bar that remains outside the skin. The bar acts as a stabilizing frame that keeps the bones properly aligned during the healing process. Once the fractured bones have healed correctly, the fixations are removed.

The multidisciplinary team of trauma and fracture experts at Northwell Health Orthopaedic Institute performs fracture repair surgery and treatment as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.

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