Wrist Surgery

UF Health Plastic Surgery and Aesthetic Center’s board-certified hand surgeon, Dr. Harvey Chim, performs surgery on a variety of wrist conditions and injuries, including wrist fractures, scaphoid fractures and wrist osteoarthritis.

Wrist Fractures

Your wrist has eight small bones that connect to the large bones in your forearm, the radius and ulna. A wrist fracture, or broken wrist, most commonly occurs when there is a break in the radius bone, which is called a distal radius fracture by hand surgeons. There are several types of fractures – non-displaced stable breaks, displaced stable breaks and unstable breaks. A non-displaced stable fracture happens when the bones do not move out of place initially. Displaced breaks need to be put back into the right place and can usually be treated with a cast of splint. Unstable fractures, even if the bones are put back in their correct position, can move or shift before fully healing. This can make the wrist appear crooked.

Some unstable fractures occur when they break apart from the smooth joint surface or they break into many pieces. In order to restore these severe types of fractures, surgery is required.


What cause a wrist fracture?
 

  • Falling down onto your hand
  • Trauma such as car accidents, motorcycle accidents
  • Falls from a ladder

People with weaker bones, such as those with osteoporosis, are more prone to breaking bones.

How do I know if my wrist is broken?

 

  • Pain and swelling
  • Difficult to move or use the hand and wrist
  • Some may still be able to move or use the hand or wrist even if there is a broken bone
  • Wrist may appear deformed
  • Often, the most severe pain occurs near the break with finger movement
  • Sometimes the fingers tingle or feel numb at the tips
Our hand surgeon will examine your wrist and obtain x-rays to see if there is a broken bone. Sometimes, tests such as a CT scan or MRI scan are needed to for better detail, to determine if other bones in addition to the wrist are injured, including ligaments, tendons, muscles and nerves.

How is a broken wrist treated?

 

Treatment depends on a variety of factors, including the type of fracture, whether it is displaced, unstable or open, age, job, hobbies, activity level, and whether it is your “dominant” hand. It may also depend on your overall health and presence of other injuries.

  • At first, you may be given a padded splint that will align the bones and support the wrist, which will help relieve some of the initial pain.
  • You may be given a cast to hold the fracture that has been set.
  • Some fractures require surgery to put the broken bones back together and hold them in the correct place.
    • Pins, screws, plates, rods or external fixation can all be used.
    • A small camera might be used during surgery to help your hand surgeon see the joint from the inside.
    • If the bone is so severely crushed that there is a gap once it has been realigned, a bone graft may be added to help the healing process.

Our hand surgeon will discuss the options that are best for your healing and recovery.

What is recovery like?

 

Recovery from wrist surgery depends on a lot of factors and it is common for it to take months to fully heal. Severe fractures may cause arthritis in the joint and occasionally require additional treatment or surgery.
To help with recovery, your hand surgeon will have you move your wrist at the appropriate time for your fracture, and may suggest hand therapy to recover full motion, strength and function.

*content adapted from the American Society for Surgery of the Hand

Scaphoid Fractures

In your wrist, you have eight small bones that make up the “carpal bones”. The scaphoid is one of these bones and it helps connect the proximal row (which is closer to your forearm) and the distal row (which is closer to your hand). Due to the location of this bone, there is extra risk for injury which usually occurs from falling on an outstretched hand.

How do I know if my scaphoid is broken?

If the scaphoid bone is broken, you may experience pain, without or without swelling or bruising on the thumb side of the wrist, a few days after falling. This pain can easily be confused as a wrist sprain because there is no visible deformity or difficulty moving, however, not being treated immediately can cause problems.

If you think you may have a fracture, please make an appointment with our hand surgeon as soon as possible.

Scaphoid fractures are usually diagnosed by an x-ray of the wrist; however, x-rays do not always show scaphoid fractures.  Your wrist will be examined and x-rays obtained, however, these types of fractures are not always detected with an x-ray. When a break in the bone is not seen on an x-ray it is referred to as an “occult” fracture. If your wrist is tender in the area near the scaphoid bone, our surgeon may suggest wearing a splint and if the pain continues, a follow-up exam and x-ray will be performed. A CT scan or MRI may also be used to diagnose the fracture.

How is a scaphoid fracture treated?

Usually if the bone has not moved out of place at the fracture, it can be treated with a cast. However, if the fracture is displaced, in a certain part of the bone or not healing quickly enough or at all, surgery might be the best option. To help alleviate pain, increase function and to prevent arthritis, surgery can be performed to clean out a fracture site, stabilize the bones with pins or screws or possibly insert bone grafts to help with healing.

What is scaphoid nonunion?

If a scaphoid fracture has not healed by 6 months, this is termed a scaphoid nonunion. The injury will likely not heal and has a high risk of future osteoarthritis.

Types of surgery may include the following:

  • Open reduction and internal fixation with bone graft
  • Vascularized bone grafts
  • Proximal row carpectomy
  • Scaphoid removal and limited wrist fusion
  • Wrist arthroplasty
  • Total wrist fusion

Our board-certified hand surgeon will evaluate your individual condition and determine the best treatment plan with you.

*content adapted from the American Society for Surgery of the Hand


Wrist Osteoarthritis

There are many different types of arthritis, but one of the most common to affect the wrist is osteoarthritis. When your wrist bones are healthy, they pass over each other smoothly and easily when you move, as they are protected by cartilage. Arthritis damages this cartilage which eventually causes the bones to rub against each other and leads to irreparable joint damage.

What causes wrist osteoarthritis?

  • Normal wear and tear in the wrist
  • Family history
  • Middle-aged or older, however it may occur in younger people as well
  • Kienböck’s disease

How is wrist osteoarthritis treated?

While there is no cure for this condition, there are many treatment options available to relieve the symptoms, including options to slow the progression of joint damage.  If nonsurgical options do not relieve the pain or improve quality of life, surgery might be the best option.

Our board-certified hand surgeon can perform a variety of surgeries on the wrist to help relieve pain and improve hand function.

Types of surgery:

  • Proximal row carpectomy – three carpal bones in the row of bones closest to the forearm are removed. This procedure helps reduce your pain and preserves some wrist motion.
  • Partial wrist fusion – if movement is what is causing the most pain, this procedure “welds” together the bones so that they heal into one, single solid bone. Cartilage is removed and then pins, plates or screws are used to fuse the joints into a permanent position. Over time, the bones grow together.
  • Total wrist fusion – if the condition is severe enough, all the carpal bones are fused together, along with the radius (one of your forearm bones). Typically with this procedure, you lose the ability to move your wrist, however, forearm rotation and finger and thumb movement are preserved.
  • Wrist arthroplasty – damaged cartilage and the bone in your wrist are removed and a metal or plastic joint surface is placed to restore function to the joint. This procedure relieves pain and provides more wrist movement than fusion.

Our board-certified hand surgeon will evaluate your individual condition and determine the best treatment plan with you.

*content adapted from the American Academy of Orthopaedic Surgeons