Fractures of the hand and wrist are among the most common orthopaedic injuries, affecting people of all ages and activity levels. The hand and wrist are highly complex structures made up of multiple small bones that provide both strength and dexterity. Because of their essential role in daily function, fractures in this region can significantly impact activities such as writing, gripping, lifting, and sports participation.

Early and accurate diagnosis is important to ensure proper healing, restore mobility, and prevent long-term complications such as stiffness, chronic pain, or deformity.

Anatomy and Physiology

The wrist is formed by eight small carpal bones arranged in two rows, which connect the forearm bones (radius and ulna) to the hand. The hand itself consists of five metacarpal bones and 14 phalanges (finger bones). The intricate alignment of these bones allows for fine motor skills, while strong ligaments and tendons provide stability and movement.

Fractures can occur in any of these bones, and the consequences vary depending on the location and severity of the injury. Because of the complexity of the anatomy, even small disruptions in alignment can affect overall function and grip strength.

Common Types of Hand and Wrist Fractures

The most frequently encountered fractures include:

• Distal Radius Fracture: The most common type of wrist fracture, often resulting from a fall onto an outstretched hand. This can range from simple, non-displaced fractures to more complex injuries.
• Scaphoid Fracture: A break in one of the small carpal bones at the base of the thumb. It typically occurs after a fall onto the hand and may be difficult to diagnose initially. Due to its poor blood supply, scaphoid fractures are prone to complications such as non-union or avascular necrosis.
• Metacarpal Fractures: These involve the long bones of the hand and are commonly associated with direct trauma, such as punching or impact injuries. They can affect grip strength and hand alignment.
• Phalangeal Fractures: Finger fractures are common and often result from direct impact or crushing injuries. Even minor misalignment can affect hand function.

Causes and Risk Factors

Hand and wrist fractures are usually caused by trauma. Common mechanisms include falls onto an outstretched hand, direct blows, sporting injuries, and accidents at work or home.

Risk factors that make individuals more susceptible include osteoporosis, reduced bone density, and participation in high-impact activities such as rugby, football, skiing, or cycling. Older adults are particularly at risk of distal radius fractures due to fragility of bones associated with osteoporosis.

• Falls onto an outstretched hand
• Contact sports
• Manual labour
• Osteoporosis (especially in older adults)

Signs and Symptoms

Typical symptoms of hand and wrist fractures include:

• Immediate pain at the site of injury, often sharp or severe.
• Swelling and tenderness over the affected bone.
• Bruising or discolouration appearing within hours.
• Visible deformity or abnormal angulation, particularly with displaced fractures.
• Difficulty moving the wrist, hand, or fingers.
• Reduced grip strength and inability to bear weight through the hand.

It is important to note that some fractures, such as scaphoid fractures, may initially present with only mild pain and swelling, leading patients to underestimate the severity of the injury.

If you have sustained a fall onto your wrist it is important that you seek professional advice asap.

Assessment and Diagnosis

A specialist assessment begins with a thorough history of the injury and physical examination. The clinician will check for tenderness, swelling, deformity, and assess range of motion. Special attention is paid to scaphoid tenderness at the base of the thumb in cases of suspected wrist injury.

Clinical Evaluation

• History and mechanism of injury
• Palpation and range of motion tests

Imaging

• X-rays are the first-line investigation for most suspected fractures, providing detail on bone alignment, displacement, and fracture pattern.
• CT scans may be used for more complex injuries to assess intra-articular involvement and surgical planning.
• MRI scans are especially useful for detecting occult fractures such as scaphoid injuries that may not be visible on initial X-rays.

Treatment Options

Non-Surgical Management

Many stable or non-displaced fractures can be treated conservatively. This typically involves:

• Immobilisation with a cast, splint, or functional brace for a period of 3–6 weeks depending on the bone and severity.
• Pain relief with analgesics and anti-inflammatory medication.
• Early referral to physiotherapy to begin rehabilitation and maintain joint flexibility once healing is sufficient.

Surgical Management

Surgery is considered when fractures are unstable, displaced, involve a joint surface, or fail to heal with conservative treatment. Surgical options include:

• Open Reduction and Internal Fixation (ORIF) using plates, screws, or wires to realign and stabilise the bone.
• Percutaneous Pinning where pins are inserted through the skin to hold the bone in place.
• Bone Grafting in cases where bone healing is delayed or compromised.

The goal of surgery is to restore normal alignment, ensure stable fixation, and allow for early movement to prevent stiffness.

Prognosis and Recovery

The recovery period varies depending on the type and severity of the fracture.

• Most simple fractures heal within 6–8 weeks, although full recovery of strength and mobility may take several months.
• More severe injuries may require 2–3 months or longer
• Early rehabilitation will help to avoid long-term stiffness, especially in the fingers and wrist.

Outcomes are generally good when fractures are treated promptly and appropriately, though complications can include malunion, delayed healing, arthritis in joint-related fractures, and persistent weakness.

When to Seek Specialist Help

You should seek immediate medical advice if you experience significant pain, swelling, deformity, or difficulty using your hand or wrist after an injury. Early diagnosis and management by a specialist can help restore function and prevent long-term problems.

At London Bridge Orthopaedics, our consultants have extensive experience in the diagnosis and treatment of hand and wrist fractures. We provide on-site imaging, expert surgical and non-surgical care, and personalised rehabilitation programmes to support patients through recovery.

FAQs

How do I know if I have broken my wrist or hand?

Common signs include severe pain, swelling, bruising, and difficulty moving your hand or wrist. In some cases, there may be a visible deformity. However, some fractures, like scaphoid fractures, can be subtle and need X-rays or further scans to confirm.

How long does it take for a hand or wrist fracture to heal?

Most simple fractures heal within 6–8 weeks, but full strength and function may take several months to return. Recovery time depends on the type of fracture, its severity, and how well the patient follows their rehabilitation plan.

Do all hand and wrist fractures need surgery?

No. Many fractures can be treated with immobilisation in a cast or splint. Surgery is usually required if the fracture is displaced, unstable, involves a joint, or has not healed properly with conservative management.

What are the risks of leaving a fracture untreated?

An untreated fracture can lead to long-term complications such as malunion (healing in the wrong position), chronic pain, stiffness, weakness, or arthritis in the affected joint.

Can I still use my hand or wrist if it is fractured?

While some movement may be possible, using the hand or wrist without treatment can worsen the injury. Immobilisation and prompt medical assessment are crucial to ensure proper healing.

When can I return to sport after a fracture?

The timing depends on the type of fracture and treatment method. In most cases, return to sport is possible after 8–12 weeks, once strength and mobility have been restored. A phased rehabilitation programme guided by a physiotherapist is recommended.

References

1. Chung, K.C., & Spilson, S.V. (2001). The frequency and epidemiology of hand and forearm fractures in the United States. Journal of Hand Surgery, 26(5), 908–915.
2. Diaz-Garcia, R.J., & Chung, K.C. (2012). Common myths and evidence in the management of distal radius fractures. Hand Clinics, 28(2), 127–133.
3. Ibrahim, T., & Taylor, G.J.S. (2012). The scaphoid fracture: a review of diagnosis and management. EFORT Open Reviews, 1(2), 59–64.
4. NHS. (2023). Broken wrist. Available at: https://www.nhs.uk/conditions/broken-wrist/ (Accessed: 1 July 2025).