Distal Radius Fracture
The radius is the larger of the two forearm bones. The end near the wrist is referred to the distal end, and the end close to the elbow is called the proximal end. Distal radius fractures are breaks in the radius bone close to the wrist. Most distal radius fractures occur when you fall onto an outstretched hand or from a car accident or other trauma. When the distal radius fractures, there will be instant pain, bruising, swelling, and limited range of wrist motion. Sometimes, the wrist will appear deformed or out of alignment.
To diagnose a distal radius fracture, I will need to take an X-ray of the wrist. An open fracture is where the bone breaks through the skin. If the fracture extends into the joint, it is called an intra-articular fracture. Fractures that do not go into the joint are extra-articular fractures.
Treatment of a distal radius fracture involves the immediate measure of stabilizing the arm and applying an ice pack. You do this to protect the injury from further insult and to decrease swelling and control pain. One nonsurgical option is casting done if the bone is in good position. I may find it necessary to straighten (or reduce) the bone to align it correctly. Surgery is necessary when the bone must be reduced through an incision. This is called an open reduction, and these procedures often require pins, plates, and/or screws to hold the bone pieces in place.
Scaphoid Fracture of the Wrist
The scaphoid bone is one of the many small bones of the wrist. It is located on the thumb side of the wrist where the bending occurs, just above the radius bone. When the scaphoid bone fractures, you will have pain, decreased wrist movement, bruising, swelling, and tenderness.
Most scaphoid fractures occur when you fall onto an outstretched hand. To diagnose a scaphoid fracture of the wrist, I will need to do X-rays to evaluate for displacement. Many times, however, a break in this area does not show up right away. If I suspect the scaphoid is fractured, I usually apply a wrist splint for a couple of weeks and have you come back for a repeat evaluation and possibly an MRI.
Treatment of a scaphoid fracture depends on the exact location of the break. Those that are near the thumb typically heal in a few weeks with protection. If the fracture is more complicated, I may apply a cast to the wrist and monitor the healing. Breaks of the middle area of the scaphoid are more difficult to heal due to limited blood supply.
I often recommend surgery for these types of scaphoid fractures. I make a small incision and insert metal implants to hold the bone in place while it heals. In rare incidences, a bone graft is necessary. Whether or not surgery is necessary, you may need to wear the cast or splint for as long as six months.
The bony aspect of the elbow that extends from the ulna arm bone is called the olecranon. This prominence is located under the skin with little protection from the soft tissues or muscles. The elbow joint consists of three bones, and these allow it to bend and straighten like a hinge. The humerus is the upper arm bone, the radius is the thumb side lower arm bone, and the ulna is the pinky side lower arm bone. When the elbow is injured, either by breaking one of these bones or by tearing a ligament that connects one bone to another, it can be stiff, painful, and unstable.
Elbow fractures occur from a direct blow, such as being hit with a baseball bat, or indirectly from landing on an outstretched arm with the elbow locked out straight. Symptoms of a fracture of the elbow include sudden intense pain, swelling, bruising, inability to straighten the elbow, numbness in one or more fingers, pain with joint movement, and tenderness. In order to diagnose an elbow fracture, I must examine the injury and take an X-ray of the joint.
Treatment depends on the extent of the injury. Some fractures of the elbow only require a splint, sling, or cast and conservative measures, while others require surgical intervention. If the bones are out of place, or if there are pieces of bone cutting through the skin, surgery will be needed.
Generally, I make an incision over the back of the elbow and hold the bone pieces and other structures together with pins, wires, plates, screws, and/or sutures. Once the surgery is over, I apply a cast for a short period of time and restrict activity to allow for healing.