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A fractured wrist is almost never life-threatening, but it can be very painful. Here is how to recognize a wrist fracture and what you need to do to get effective treatment.

Every year in the United States about 250,000 people seek treatment for fractures of the wrist. About 34 percent of women and 17 percent of men who suffer wrist fractures have osteoporosis. A fractured wrist is often the first sign of osteoporosis. When the underlying problem is osteoporosis, there is a 200 to 400 percent increase in risk of a future wrist fracture compared to people who have not had wrist fractures.

What are the signs that wrist has been broken?

Not every wrist fracture produces all of these symptoms, but the greater the number of symptoms, the more likely it is that there has been a fracture:

  • Pain (this is almost always present)
  • Bruising
  • Swelling
  • Deformity (the wrist seems misshapen)
  • Numbness
  • Tingling
  • Burning sensations
  • Limited mobility of the wrist

Of course, if a broken bone is visible through the skin, a fracture has occurred.

Is it a fracture or a sprain? Fractures of the scaphoid bone of the wrist are frequently mistaken for sprains. There are some tell-tale signs that an injury to the wrist is a fracture and not a sprain. Sprains usually cause swelling. Scaphoid fractures usually do not, except at the thumb's "snuffbox," a small depression at the base of the thumb. A scaphoid fracture will usually cause dull, deep pain on the thumb side of the wrist. This pain gets worse when gripping or pinching an object. 

If pain doesn't go away in 48 hours or less, then it is necessary to go to a doctor to get an X-ray to determine whether any of the wrist bones has been fractured.

Don't focus on the wrist and ignore more serious injuries.The first thing to do if you are on-site when a fracture of the wrist may have occurred is to look for other injuries. The patient must be able to breathe. If there appear to be head, neck, or back injuries, don't move the patient until emergency medical technicians or paramedics arrive. If there is broken skin, clean away dirt with sterile water, if available. Otherwise, cover an open wound with a light, clean dressing, if available.

First aid for a fractured wrist

A good approach for any wrist injury is the PRICE protocol:

  • Protect the wrist from further injury. This usually involves a splint or brace.
  • Relative rest allows the wrist to heal. Avoid activities that cause pain, but use the wrist as much as possible to promote circulation.
  • Ice should be applied for 10 to 15 minutes every one to two hours or so as desired. Don't pack ice directly against the skin. Place a clean cloth between the ice and the skin to prevent frostbite. Intermittent ice therapy is better than continuously packing the wrist in ice. Discontinue ice if the skin appears red, raised, or mottled.
  • Compression, such as a compression bandage, helps prevent further injury. The wrap is applied starting a few cm (about an inch) below the injury in a spiral to a point a few cm (another inch) above the injury. The bandage should not be so tight that it causes tingling, numbness, or changes in skin color.
  • Elevation reduces swelling. With less swelling, there is less pain, easier motion, and accelerated recovery.

Only a doctor can make the diagnosis of a fracture, usually after an X-ray examination. Most fractures of the wrist are not due to osteoporosis, and heal in eight to twelve weeks with proper treatment. However, for some people, one wrist fracture is a warning sign of another, and further examination is a must.

Do you need a medical exam to rule out osteoporosis?

Most people who experience fractures of the wrist do not have osteoporosis. However, among those whose injury is in part due to the brittle bone disease, there is a much greater risk of future fractures not only of the wrist but also of the hips and spine. Some people need to have further medical examination to rule out osteoporosis whenever there is a fracture of the wrist:

  • Any woman who is over the age of 65 at the time she fractures her wrist need to be examined for osteoporosis. Usually this would involve a painless and relatively inexpensive DXA examination that is read by a radiologist and/or an endocrinologist specializing in osteoporosis.
  • Any woman who is over the age of 60 and has risk factors for osteoporosis at the time she fractures her wrist also needs to be examined for osteoporosis. These risk factors include a personal history of fractures after relatively mild trauma, Asian or Caucasian race, early menopause, family history of osteoporosis, and use of medications that increase the risk of bone mineral loss such as glucocorticoids for autoimmune disease, certain older medications for epilepsy, and SSRI antidepressants.
  • Any man over the age of 70 at the time of a first wrist fracture should also be examined for bone mineral loss. Osteoporosis is increasingly a recognized problem of older men.
  • Anyone of any age who has been on "steroids" for six months or longer at the time of a fractured wrist needs to be examined for osteoporosis. About half of people who use glucocorticoids, even in low doses, develop some degree of osteoporosis. Treatments to rebuild bone or modifications of steroid treatment may be necessary.

Emergency rooms are usually not places that make referrals for treatment of chronic diseases. Your ER doctor probably will not refer you to an osteoporosis specialist. (An orthopedic surgeon is not an ER specialist.) You may have to exert polite persistence to get the testing you need to get the treatment you need to prevent future fractures.

  • Beattie K, Adachi J, Ioannidis G, Papaioannou A, Leslie WD, Grewal R, MacDermid J, Hodsman AB. Estimating osteoporotic fracture risk following a wrist fracture: a tale of two systems. Arch Osteoporos. 2015.10:13. doi: 10.1007/s11657-015-0218-3. Epub 2015 May 9.PMID: 25957065.
  • Bleibler F, Rapp K, Jaensch A, Becker C, König HH. Expected lifetime numbers and costs of fractures in postmenopausal women with and without osteoporosis in Germany: a discrete event simulation model. BMC Health Serv Res. 2014 Jun 30.14:284. doi: 10.1186/1472-6963-14-284. PMID: 24981316.
  • Caffarelli C, Alessi C, Nuti R, Gonnelli S. Divergent effects of obesity on fragility fractures. Clin Interv Aging. 2014 Sep 24.9:1629-36. doi: 10.2147/CIA.S64625. eCollection 2014. Review. PMID: 25284996.
  • Photo courtesy of SteadyHealth

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