Overview
A broken wrist almost always means a fracture of the distal radius, the flared end of the larger forearm bone that forms most of the wrist joint. If its joint surface heals tipped backward, shortened or with a step, the wrist loses motion, grip weakens and the joint wears prematurely. Restoring that geometry is the whole aim of treatment.
Three questions decide the plan: how far the fragments have moved, whether they will stay in position once realigned, and what the patient needs from the wrist. X-ray measurements answer the first two; age and activity answer the third. A minimally displaced fracture heals well in a cast. A displaced, unstable or intra-articular fracture in an active adult is fixed with a plate so the wrist can move early and heal in the right position.
Common Symptoms
- Immediate pain and swelling at the wrist after a fall
- A visible deformity, classically a dinner-fork shape with the hand displaced backward
- Swollen fingers that are hard to bend, and pain with forearm rotation
- Numbness or tingling in the thumb, index and middle fingers, which signals pressure on the median nerve and needs same-day review
Deep pain on the little-finger side that persists once the swelling settles can be a TFCC tear, which accompanies many distal radius fractures. Deformity higher up the arm means a forearm fracture. Tingling that starts in the cast is carpal tunnel syndrome from swelling and should be reported, not waited out.
Causes & Risk Factors
The mechanism is a fall onto an outstretched hand with the wrist bent back. In younger adults that means cycling, snowboarding, skateboarding and contact sports, and the fracture is usually displaced and often into the joint. Over 60, a fall from standing height is enough, especially in women after menopause; a wrist fracture from a simple fall is often the first sign of osteoporosis, and Dr. O'Donnell treats it as a reason to check bone density. Children are almost always managed in a cast.
How It Is Diagnosed
The exam looks for what the X-ray will not show. Dr. O'Donnell checks the skin, tests median nerve sensation, feels the anatomical snuffbox for a scaphoid fracture, checks the ulnar side of the wrist and the elbow, and confirms the fingers move.
X-rays in three views make the diagnosis and provide the numbers that decide treatment. As a general rule, backward tilt of the joint surface of more than about 10°, radial shortening of more than about 3 mm, or a joint step of more than 2 mm in an active adult are indications to fix the fracture. CT maps the fragments of intra-articular fractures before surgery; MRI is reserved for a suspected scaphoid fracture that does not show on X-ray. Films taken elsewhere can be uploaded through mymedicalimages.com.
Treatment Options
Non-operative care
Fractures that are undisplaced, or that sit within the limits above after they are reset, are treated in a cast. When the fragments have moved, Dr. O'Donnell performs a closed reduction under local anesthetic injected into the fracture, pulling the bone out to length and tipping the joint surface forward, then applies a molded splint and confirms the position on X-ray. X-rays are repeated weekly for three weeks, because a reset fracture can slip and the decision to operate is better made early than late. The cast comes off at about six weeks, and therapy restores motion and grip over the following six to eight weeks.
Volar plate fixation
For displaced, unstable or intra-articular fractures in active adults, and fractures that slip in the cast, Dr. O'Donnell performs open reduction and internal fixation, described on the wrist and forearm fracture fixation page. Through an incision on the palm side of the forearm, the fragments are realigned under X-ray and held with a low-profile plate and locking screws that grip even soft bone, rigid enough that wrist motion begins within one to two weeks instead of after six weeks in a cast. Surgery is scheduled within one to two weeks of injury, as an outpatient at Bayside Surgery Center under a nerve block with general anesthesia, and the plate normally stays in permanently.
Recovery & What to Expect
A cast-treated fracture is immobilized for about six weeks and then rehabilitated; a plated fracture follows Dr. O'Donnell's distal radius protocol below. In both, finger motion is maintained from day one, because stiff fingers are the most common avoidable problem.
| Phase | Timing | What happens |
|---|---|---|
| Digit & early wrist motion | Weeks 0–2 | Removable splint between exercises; full finger, elbow and shoulder motion; tendon gliding; gentle active wrist and forearm motion as directed. No gripping loads or weight bearing. |
| Wrist motion | Weeks 2–6 | Active wrist motion in all planes progressed toward full; scar mobilization. No resisted strengthening or lifting; X-rays checked for healing. |
| Strengthening | Weeks 6–12 | Once Dr. O'Donnell confirms healing on X-ray: progressive grip, wrist and forearm strengthening, work conditioning. |
| Return to activity | Months 3–6 | Sport- or job-specific loading; full loading and contact on surgeon clearance. |
Typing in the splint resumes within the first week after fixation; driving at four to six weeks once the splint is off; cycling, tennis, golf and gym loading through the wrist once union is confirmed at about six to eight weeks; and contact sports at about three months. Cast-treated patients start the motion phase when the cast comes off. The protocol is available as a PDF: distal radius fracture ORIF.
Frequently Asked Questions
Does a broken wrist always need surgery?
No. Fractures that are undisplaced, or that can be reset and stay within accepted alignment limits, heal well in a cast for about six weeks. Surgery is recommended when the joint surface is tilted, shortened or stepped beyond those limits in an active adult, or when the fracture slips in the cast.
How long does a wrist fracture take to heal?
The bone is usually solid enough at about six weeks to start strengthening, whether casted or plated. Motion and grip take another six to twelve weeks, and the wrist keeps improving for up to a year. A plated wrist moves in the first two weeks, so it generally reaches full function sooner.
When can I drive after a wrist fracture?
Once the cast or splint is off, the wrist can rotate and grip the wheel comfortably, and you are off narcotic pain medication. After plate fixation that is usually four to six weeks; after cast treatment, when the cast comes off at about six weeks.
Will I get arthritis from a wrist fracture?
It depends on how the joint surface heals. A step of more than a couple of millimeters raises the chance of arthritis over the following years, which is the main reason intra-articular fractures in active adults are fixed rather than casted. A fracture that heals with a level joint surface rarely causes arthritis.
What if my fingers are tingling in the cast?
Call the office the same day. Tingling in the thumb, index and middle fingers means the median nerve is under pressure from swelling or the cast, and it is treated by loosening or splitting the cast and elevating the hand, not by waiting.
This page is for general education and is not a substitute for a medical evaluation. Treatment recommendations depend on your individual diagnosis and goals. Kevin O'Donnell, MD sees patients from Coral Gables, Miami, Brickell, Pinecrest and Coconut Grove at 475 Biltmore Way, and out-of-town patients by telemedicine.