Broken wrists are common work-related injuries. Although a"broken wrist" can indicate a number of different injuries, usuallyit refers to a fracture of the end of the radius bone at the wrist,or "distal radius fracture." Usually, distal radius fractures are aresult of a fall on an outstretched hand.

In the past, orthopaedic surgeons treated most distal radiusfractures with casts. Recently, this has been changing due to theresults of an extensive study of the problem. Although thesefractures usually do heal in a cast, they may not heal in theproper alignment. This may lead to problems over the long term,including arthritis and wrist instability. To prevent theseproblems, it is very important for the wrist to heal close to itsoriginal anatomic position, and often the surest way to ensure thatthis happens is with surgery. The surgery usually involves openingthe wrist, putting the bones in the right position, and thenholding them in that position with a plate and a number of screws.The plate and screws hold the bone until it heals. After the boneheals, they are no longer necessary. However, because it meansadditional surgery to take the plate out, it is usually left inplace forever.

Distal radius fractures treated in the traditional manner areusually casted for six weeks, followed by therapy to restore rangeof motion. Surgically treated fractures are typically not casted,but are protected in a removable splint, which allows therapy tobegin much earlier. This earlier motion, with less residualstiffness, is one of the advantages of operative treatment.

According to a 2007 study, average return-to-work time after adistal radius fracture was about nine weeks, although 20 percent ofparticipants reported no lost work time (probably as a result oftheir specific occupation). The most important predictors of timelost were occupational demands and self-reported disability.

Another study from Canada looked at the level of disability sixmonths after a distal radius fracture. Similar to what has beenfound in a number of workers' compensation studies related toorthopaedic injuries, patient factors rather than injury ortreatment factors were found to be more predictive of disability.Injury compensation was the best predictor of pain and disabilityat six months. Patient education level and initial radialshortening (a measure of fracture severity) were also predictive.The majority of the patients in the study had very low disabilitylevels at six months.

Although most distal radius fractures treated appropriately healwith few functional limitations, some degree of stiffness iscommon. Other potential complications include infection, carpaltunnel syndrome, and arthritis. As with any upper extremity injury,reflex sympathetic dystrophy is a feared, often devastatingcomplication. It is fortunately rare, but can result in significantdisability when it occurs, even in spite of appropriatetreatment.

There is a spectrum of treatments and outcomes for distal radiusfractures. It may require some time to accomplish healing, but mostpatients return to their previous occupations uneventfully.