Wrist Injuries

Coronavirus / COVID-19 update

During the COVID-19 risk period, wherever possible we’ll be reducing face-to-face appointments and helping you manage your injury remotely. This means that, in accordance with the British Orthopaedic Association guidelines, your individual treatment and follow up plan may be different to what happens under normal conditions. An orthopaedic consultant or a member of the orthopaedic team will always review your notes and x-ray and decide if a face-to-face follow up is necessary.

If we haven’t asked to see you for a follow up, we may offer you an open appointment, where you can make an appointment to see someone at any time in the six months after your injury. If you’d like to book an appointment, please call 01736 758892.

Medication

The Emergency Department (ED) or a Minor Injury Unit (MIU) may have prescribed you with some pain relief. Take these as instructed to help manage the pain.
If you do not feel that this medication is helping, talk to us during your appointment in Fracture Clinic, or your GP, about an alternative option.

Cold packs

Ice is a great natural anaesthetic that helps relieve pain and controls swelling. Apply ice packs or a bag of frozen peas wrapped in a wet thin towel to your wrist for up to 15 minutes every few hours.

• Do not place ice in direct contact with the skin.
• Do not leave the ice pack on for more than 20 minutes at a time in one hour.

Rest and elevation

It’s important to rest your wrist as much as possible in the first 24 to 72 hours.

You may have been fitted with a plaster and given a sling or you may have been put straight into a removable splint called a futuro splint. Keep your wrist elevated in the sling with your hand at heart level. This will help to reduce your swelling and pain.

During the evening and at night, you may find it more comfortable to elevate your arm on a couple of pillows.

Smoking

Medical evidence suggests that smoking prolongs fracture healing time. In extreme cases it can stop healing altogether. Stopping smoking during the healing phase of a fracture will help ensure optimal recovery from this injury.

For advice on stopping smoking and local support available, please discuss this with your GP or go to the NHS Smoke Free website.

Using your sling

Wear your sling during the day. You can take it off to wash, dress and exercise. You don’t need to wear it at night.

You can see more about how to fit your sling, and washing, dressing, sleeping and sitting with your sling in these videos.

If you’re struggling with your sling, please call the Fracture Clinic on 01872 253091 and we’ll be happy to give you advice.

If you’ve been given a plaster cast

We may need to manage your wrist injury by using a plaster cast to encourage healing and good alignment.

Keep your cast clean and dry. You can find out more about caring for your plaster cast here.

You can expect to have your cast removed after 5 to 6 weeks, or earlier for a child. We may use a soft cast so that you can take the plaster off at home without visiting us. We’ll explain this to you when we remove your cast.

Watch this video on how to remove your soft cast.

If you have significant problems with your cast call the plaster room on 01872 253234 or attend ED out of office hours.

How to manage your wrist after the cast has been removed

We recommend that you:

• soak your wrist in warm water if it’s swollen or it aches
• massage it regularly with oils or hand cream directed over the wrist and towards your elbow
• elevate your hand and arm on pillows if they feel swollen and keep your fingers moving
• keep your shoulder and wrist moving to reduce stiffness
• use your wrist, hand and arm as normally as possible when we tell you to do so.

The information below will help you understand your injury, guide you through your rehabilitation and explain what you can do to maximise your recovery.

Your diagnosis should have been made by an orthopaedic consultant or one of the team working under the supervision of the consultant team. The information in these care plans is to help you understand your diagnosis and is not exhaustive. Your consultant may give you a different, personalised care plan based on your injury and discuss whether you need imaging (x-ray, CT scan, MRI or an ultrasound) or an operation.

What is your injury?

You have broken one or two bones in your wrist:

• The radius, which is on the side of your thumb,
• the ulna, which is on the side of your little finger,
• or both.

These are among the most common injuries we treat in fracture clinic.
They’re usually caused by a fall on an outstretched hand that forces the wrist backwards. They’re common in young children and older people.

Healing

It normally takes up to 12 weeks to heal, and longer to regain full strength and movement, but this may differ depending on your individual circumstances. For example, children heal quicker than adults. We’ll discuss how long we expect your injury to take to heal with you, and whether you’re likely to need an operation.

If you don’t need, or choose not to have an operation, you’ll be in a plaster cast for 4 to 6 weeks (children will need a cast for less time as they heal quicker, usually less than five weeks).

It is important not to put any weight through your wrist for 6 weeks after your injury. You can put weight through your elbow.

Follow up

If we need to follow up with you, either on the phone or face to face, we’ll contact you by phone to arrange. If you need an operation, we’ll discuss this with you and help you make an informed decision

You can also book an open appointment to see someone about your wrist at any time in the 6 months after your injury. Please call 01736 758892 to make an appointment.

Please call the Fracture Clinic on 01872 253091 if:

• you’re unable to follow this rehabilitation plan
• you have any questions
• you’re struggling with your sling
• you notice pain in an area other than your wrist.

In some cases you may need an operation to realign your bones. This may involve putting wires, plates, screws or rods inside your arm. Sometimes we may need to use a temporary external frame.

What are the risks with surgery?

If you’re overweight, smoke or not active, you’re at greater risk of developing complications after surgery. It may take longer to recover.

Possible complications that you should be aware of include:

• scarring on the wrist
• tendon, nerve or vessel damage around the wrist joint
• infections, which we can treat with antibiotics
• further surgery if wounds become more deeply infected
• nerve pain (in rare cases) which may need further treatment
• further surgery if the fracture is not stable or does not heal properly.

Most complications are minor and can be treated easily and successfully.

How long will I spend in hospital?

Wrist surgery patients generally go home the same day. You may need to spend one night in hospital.

After surgery you’ll need to strictly rest and elevate your arm. You can expect to be up and active within 48 hours. Your surgeon will tell you more about this.

Managing your injury after surgery

You may need a sling to protect your wrist and manage swelling. Use it for 1 to 2 weeks, but not longer as it’s important that your elbow doesn’t get stiff.

More information about having an operation

You can find out more about having an orthopaedic operation here.

Wrists get stiff very quickly. Keep your fingers, elbow and shoulders moving as normal while you are wearing your cast.

The exercises here will help you regain range of movement in your wrist, hand and elbow.

Exercises to do whilst in your plaster cast

Exercise 1

Support your elbow on a table with your wrist straight and your fingers pointing towards the ceiling.
Make a fist with your thumb over your fingers.

Straighten your fingers and bring them apart. Repeat 10 times.

Exercise 2

Put the back of your hand on a table.

Bring your thumb to the base of your little finger. Continue to bring your thumb to touch the base of each finger. Repeat 10 times.

Exercise 3

Place the palm of your hand on a table.

Bring your thumb away from the index finger and then back again.

Wrist and hand exercises for after your cast or splint has been removed

Do these exercises every day for 6 weeks once your cast or splint has been removed. These exercises increase in intensity, so work through at your own tolerance.

Try to complete all exercises.

You should:

• take painkillers 20 to 30 minutes before starting your exercises
• complete the exercises on both wrists
• do the exercises little and often
• start with your forearm resting on a table to make it easier
• expect some discomfort (but sharp pain and increased swelling indicates you’re overdoing it).

Exercise 4

Fully bend your wrist forward 10 times. Try to bend your wrist a little more. Hold for 30 seconds.

Exercise 5

Fully straighten your wrist upwards 10 times. Try to straighten your wrist a little more. Hold for 30 seconds.

Exercise 6

Rest your forearms on a table, palm turned down. Alternate turning the palm up and down. Repeat 10 times.

Tip: Use your other hand to gently assist the injured wrist to gently help increase the end range of movement.

Exercise 7

Bring your hands into prayer position with your fingertips pointing towards the ceiling. This may be difficult at first but with practice it should become easier.

Try to keep your hands in prayer position but reverse it with your fingertips pointing towards the ground. Repeat 10 times.

Strengthening exercises to begin 12 weeks after your injury

Do these when you have regained maximum range of motion, you’re pain free and 12 weeks have passed since your injury.

Grip strength

Squeeze a soft ball in your hand. Hold for up to 30 seconds. Repeat 5 times.

Using a small weight

Do exercises 4 and 5 above but hold a small weight (0.5 kg) in your hand. Gently bend your wrist and straighten it with the weight in your hand.

Hold for up to 30 seconds in each direction. Repeat 5 times.

Alternatively use a yellow or red TheraBand and perform the same exercise.

You can also follow exercise 6 above using a small weight.

Caring for your wound

If you’ve had an operation on your wrist, you’ll need to keep your stitches dry and clean. You should also look out for any redness or signs of swelling, bleeding or pus as these can be signs of an infection.

You can find information about how to care for your stitches, if/when they need to be removed and signs of an infection on our orthopaedic surgery page.

Blood clots and Deep Vein Thrombosis (DVT)

Because your limb is immobilised and you’ll be moving less than normal, you’re at higher risk of developing a blood clot or Deep Vein Thrombosis (DVT). The risk of DVT with a wrist injury is low, but it can still be life threatening if left untreated.

Symptoms of DVT in the leg are:

• throbbing or cramping pain in 1 leg (rarely both legs), usually in the calf or thigh
• swelling in 1 leg (rarely both legs)
• warm skin around the painful area
• red or darkened skin around the painful area
• swollen veins that are hard or sore when you touch them.

These symptoms can also happen in your arm or tummy if that’s where the blood clot is.

More information about DVT

• Watch this video about how to prevent DVT
• Learn more about DVT including symptoms, who is at risk and how to treat it on the NHS website
• Find out how to reduce the risk of blood clots when you have an immobilised lower limb (PDF, 108KB).

Pressure Sores and Ulcers

Wearing a brace and not moving your limb can lead to pressure sores or ulcers. These are injuries to the skin and underlying tissue caused by prolonged pressure, rubbing or tension.

They often develop gradually, but can sometimes form in a few hours.

Signs and symptoms of a pressure sore include:

• skin discolouration – red patches for people with pale skin, purple or blue patches for people with dark skin
• discoloured patches that do not turn white when pressed
• a patch of skin that feels warm, spongy or hard
• pain or itchiness in the affected area.

Take your brace off every day to check your skin. Make sure it’s not rubbing.

More information about pressure sores and ulcers

• Watch this video about how to prevent pressure sores
• Read more about pressure sores on the NHS website

If you think you have a pressure sore or ulcer

Call the Fracture Clinic straight away on 01872 253091. For out of hours advice please call 01736 758909.

Sepsis

Sepsis (also known as blood poisoning) is a serious infection that can be life threatening. There is no one sign for sepsis so it can be hard to spot.

Call 111 immediately if you develop any of the following:

• Slurred speech or confusion
• Extreme shivering or muscle pain
• Passing no urine in a day
• Severe breathlessness
• It feels like you’re going to die
• Skin is mottled or discoloured.

Find out more about the symptoms of sepsis on the NHS website.

These videos also explain what Sepsis is and how to spot the early signs.

Driving

Wait at least two weeks after your injury or surgery. After that, you can return to driving when:

• you have been told you no longer need your sling
• we’ve removed your cast (if you had one)
• you’re able to turn the steering wheel comfortably and without any pain
• you can control the vehicle safely
• you’ve checked it’s ok to drive with your insurance company.

Always test your ability to drive with the ignition off and in a safe environment.

If you have a follow up appointment with us, please wait until your consultant or physiotherapist has given you clearance to drive. If you are in any doubt, do not drive until you have spoken to our team.

Work

Decisions to return to work are made on a unique basis and should be discussed with the Fracture Clinic, your GP and your employer.

You may need time off work and when you return, you may need light or amended duties. When you should return to work will depend on your profession and your injury.

You can get a fitness to work statement or a sick note when you come into the Fracture Clinic. If you don’t need to come and see us, you can get one from your GP.

Sport

You should not do any sports or heavy lifting for at least 12 weeks, but possibly longer, depending on your injury.