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I have a particular interest in and enjoy managing fractures of the wrist. The radius is the most commonly fractured bone in the arm. Most commonly the injury occurs after a fall on an outstretched hand but can happen as a result of a car accident, bicycle accident or similar.

The pattern of the fracture, whether it is out of position or involves the joint surface are factors in determining the treatment. Other important considerations include your age, overall health, hand dominance, work and leisure activities, the presence of any prior injury or arthritis, and any associated injuries.

A period of treatment in a cast may be all that is required if the fracture is in a good position. For fractures which are out of position or in multiple pieces surgery is likely to be recommended. The aim of surgery is to enable the bones to heal in the position they were in prior to the injury. This gives the best chance of regaining full movement and function. To this end a titanium plate may be inserted to hold the bone in an acceptable position while it heals.

While the wrist fracture is healing, it is very important to keep the fingers flexible. Once the wrist has enough stability, motion exercises may be started for the fingers and the wrist itself. A removable splint is usually worn for 6 weeks.

Recovery time varies considerably, depending on the severity of the injury, associated injuries, and other factors. It is not unusual for maximal recovery from a wrist fracture to take several months. Some patients may have residual stiffness or aching. If the surface of the joint was badly injured, arthritis may develop. On occasion, additional treatment or reconstructive surgery may be needed.

Wrist fractures and Vitamin C

I am often asked by patients what they can do to help their bones heal better or faster. The main answer to this lies in letting the body do what it wants to do naturally (that is healing) and avoiding interfering in this process by smoking, drinking excessively or moving the broken bone too soon.
An exception to this is Vitamin C as an adjunct to healing of wrist and ankle fractures.1, 2 A minority of fractures go on to be stiff, painful, red and swollen (a.k.a complex regional pain syndrome) for no obvious reason even when the bones have healed in a good position. The incidence of this is halved if Vitamin C is taken whilst the fracture is healing. This is at little cost and minimal risk of side effects but is often overlooked in the management of a healing fracture. For this reason I recommend my patients take 500mg (usually one tablet) of Vitamin C each day while their fracture is healing.

[1] Zollinger PE, Tuinebreijer WE, Breederveld RS, Kreis RW. Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? A randomized, controlled, multicenter dose-response study. J Bone Joint Surg Am. 2007 Jul;89(7):1424-31.

[2] Besse JL, Gadeyne S, Galand-Desmé S, Lerat JL, Moyen B. Effect of vitamin C on prevention of complex regional pain syndrome type I in foot and ankle surgery. Foot Ankle Surg. 2009;15(4):179-82. Epub 2009 Apr 5.