I Fell on the Ice! Could I Have Broken My Wrist?
Jeffrey M. Jacobson, Hand Surgeon
January 27, 2020
When the temperature drops, wrist injuries rise. Find out about common injuries and the good news about recovery.
Any time the weather forecast includes a good ice storm, my wife looks at me and says, “You are going to be late tonight, aren’t you?” As both a hand surgeon and avid mountaineer and skier, I’m well acquainted with falls and the damage they can do, particularly to the hand and wrist. Wrist fractures account for one-sixth of all emergency department visits for fractures. Doctors treat hundreds of thousands of wrist fractures every year.
If you fall and hurt your wrist, see a hand surgeon or go the emergency department or urgent care if you have the following symptoms:
- Significant pain, especially during movement
- Hand or wrist looks visibly deformed
- Bruising on your wrist (even though it was your hand that hit the ground)
- Feel you may have broken or injured it, regardless of reason
Common wrist injuries
Not every fall results in a serious injury. Sometimes you get lucky and just sprain or bruise your hand, for which a short course of rest, ice and possibly a medication such as ibuprofen may take care of it. If it’s something more serious, chances are you have one of two common wrist injuries:
Distal radius fracture. This is one of the most common fractures in the human body. The forearm consists of two bones connecting the elbow to the hand: the radius is the bone on the thumb side, and the ulna on the pinkie side (near the wrist, this breaks too, but not as often as the distal radius).
While it’s never fun to break a bone, the news isn’t all bad. Our hands and wrists are designed to handle these injuries well most of the time. In fact, falling on our hands keeps the impact away from the face, head and brain, which are often more serious injuries.
Minor fractures that don’t involve the joints are usually put back into place and casted for 6 to 8 weeks. More severe fractures, particularly where alignment of the joint surface is affected, often requires surgery. There have been terrific advances in the treatment of distal radius fractures in the last two decades, notably with the use of tiny, low-profile titanium plates that surgeons slide in near the fracture site to align and stabilize the bones. The outpatient procedure takes one to two hours under guided imagery. You generally don’t feel the plate – and sometimes don’t even need a cast or splint. Recovery is sometimes faster with surgery compared to treatment with a cast.
SL tear. SL stands for scapholunate ligament, the fibrous tissue that connects two of the small carpal bones (the scaphoid and the lunate) together near the center of the wrist. The ligament ensures the bones move in unison and the wrist has a smooth rotation. When it is torn, the bones separate and move in different directions, resulting in pain and loss of grip strength. SL tears can sometimes occur with a distal radius fracture, or by themselves.
This is a classically missed injury that requires a high-degree of suspicion on the part of the examining physician as well as sometimes needing a non-standard x-ray view. Very often, the initial pain fades and it’s chalked up to a sprain. Over time, sometimes years, the wrist will then wear out, requiring surgery to salvage what remains of the worn-out joint.
Of course, the best approach is to be proactive. Be mindful that when it’s icy, if you are prone to falls, have bad balance or are elderly (and have weaker bones or osteoporosis), you should consider re-scheduling that appointment for another day. Test the railings before you venture down – this is an extremely common cause of falls. Stick to non-slick surfaces for walking and consider micro-spikes for your shoes. While no footwear is guaranteed to prevent a fall, commercially available metal cleats easily slip over your shoes or boots and can help to stabilize on slippery surfaces tremendously.
Dr. Jeffrey M. Jacobson is a hand surgeon and plastic surgeon with White Plains Hospital Physician Associates, practicing at our Armonk and Larchmont locations. To make a appointment, call (914) 421-0123.
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