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In the dojo, the most common cause of broken wrists is a fall in which the martial artist attempts to lessen the impact by extending an arm to make first contact with the floor. A less-common cause is a direct blow that hits the wrist.
When you consider how important the wrist is in the delivery of power—as well as in locking, grabbing and escaping from grabs—it pays to know the physiological limits of the joint. And for times when the worst-case scenario happens, it’s beneficial to know what to expect when a wrist is broken.
First, the anatomy. The wrist joint is designed to allow many degrees of movement: flexion, extension, radial and ulnar deviation, and supination (turning the palm up) and pronation (turning the palm down). The distal radius and ulna form the wrist bone and connect to the hand (carpal) bones through ligaments. The distal radius and ulna are also connected to each other by ligaments.
When we talk about wrist fractures, we’re referring to a break in the distal radius and/or ulna at the level of the metaphysis, which is the flared region of a bone. In children, an injury to the wrist bone can consist of damage to the growth plate because they’re not skeletally mature yet. Children also can suffer an incomplete fracture, wherein only one side of the bone is broken. Yet another common injury in young martial artists is a buckle fracture, which follows a compressive load through the distal radius. And, of course, kids can sustain a complete fracture just like adults.
For a mature martial artist, a wrist fracture is either displaced or undisplaced, and it involves the distal radius and/or the ulna. “Displaced” means there’s been a shift in position between the two broken parts. “Undisplaced” means there has been no movement or shift.
An undisplaced fracture is treated nonoperatively. The wrist is immobilized with a secure splint or a cast. The injury generally takes four to six weeks to heal.
When the wrist fracture is displaced, it usually warrants a reduction to properly align the bone(s). Getting the wrist into adequate alignment is important because if it heals in a crooked position, it will pose problems in the future. Those problems may include pain, stiffness and decreased grip strength.
When you sustain a wrist injury, the medical assessment will involve X-rays. If a reduction is required for a displaced fracture, another X-ray will be obtained after the reduction to judge the quality of the procedure. If the alignment is acceptable, the injury may be treated in a cast and closely monitored. If, at the next follow-up appointment, the wrist bones have shifted again despite being in a cast, surgery will be needed.
For unstable wrist fractures—those whose alignment cannot be maintained in a cast—surgery will probably be recommended. The decision to undergo surgery should take into account factors such as the patient’s age, activity level and overall health.
The postoperative course also should be individualized. If the bone quality is good and the fixation is strong, early range-of-motion therapy can be initiated. If the bone is soft and the fixation questionable, therapy may be started later to minimize the risk of further fracture displacement.
It takes effort to undergo the therapy needed to recover from a wrist fracture. Even when that happens, the joint can feel stiff and it can take months to regain motion, strength and baseline functionality. If the fracture is severe and/or the treatment is not optimal, there’s a possibility you won’t regain all the motion, strength and functionality you had. That’s why it’s imperative that you seek medical attention anytime you suffer a wrist injury that might involve a fracture.
