Video transcript

Let’s talk about your wrist fracture and what to expect going forward.

You have two bones in your forearm. On the thumb side is the radius, which plays the main structural role in the wrist. The other bone is the ulna, which also contributes to the wrist joint, but is less structurally important.

A break at the end of the radius – near the wrist – is called a distal radius fracture. It’s one of the most common types of fractures and usually happens after a fall onto an outstretched hand.

There are a few important things to understand about this injury. Sometimes the break is significantly out of position – what we call displaced. If that happens, we may need to manually adjust the position of the bones early on, to help the fracture heal in better alignment.

Another key factor is whether the break extends into the wrist joint itself. The wrist relies on a smooth joint surface to move properly. If the fracture goes into that surface, there’s a higher risk of long-term problems like stiffness or discomfort. These cases often need more careful monitoring. In particular, we assess how well the joint surface lines up after any manipulation or surgery, as even small irregularities can cause problems later.

When the injury is first picked up on X-ray, most people are placed into a plaster cast. If the fracture is out of position, a manipulation may be done first to improve the alignment. This is often done on the same day, and most people are able to go home afterwards. Pain relief and a local anaesthetic are usually used to make this procedure more comfortable.

Many wrist fractures can be treated without surgery – especially in patients over 65, or where the joint surface has not been badly disrupted. But for younger patients, or for injuries involving the dominant hand or affecting the joint surface, surgery may be more likely.

That decision is made by the orthopaedic team based on your X-rays and your individual situation – including things like age, hand dominance, and activity level. We also consider whether the fracture is likely to stay in position throughout healing – if not, surgery may be recommended to prevent later problems.

If you’re managed in a cast, you’ll usually be seen in the fracture clinic a few days after the injury. We often repeat X-rays during the first two weeks to make sure the bones stay in a good position. A below-elbow cast is normally used, and stays on for four to six weeks. In some less severe injuries – especially in older adults – it may be possible to switch to a removable splint after three or four weeks. This can allow a bit more flexibility with hygiene and comfort, as long as the fracture is stable.

Once the bone has had time to heal, we’ll remove the cast in clinic and refer you to the hand therapy team. These specialist physiotherapists will guide you through rehab exercises to help restore movement, strength and function in the wrist. At first, this may focus on simple stretching and gentle movement, before gradually building up strength and grip.

Sometimes, even when the fracture initially looks fine, the position can change in the first week or two. If the bone starts to drift out of place, surgery may be offered – even if the original plan was non-operative. This doesn’t mean anything has gone wrong. It just means the fracture is less stable than it first appeared, and a cast alone isn’t holding it well enough.

If surgery is needed, it may involve manipulation under anaesthetic, temporary wires, or more commonly, a metal plate and screws. This is usually done through a small cut on the palm side of the wrist, and helps keep the bone in the correct position while it heals. Plates are often chosen because they allow earlier movement and reduce the chance of the fracture slipping again.

Some patients may also experience nerve symptoms. The median nerve runs through the wrist and controls sensation in the thumb, index, and middle fingers, as well as fine finger movements. If you notice tingling, numbness, or weakness in those fingers, tell the clinical team – we may need to check whether the nerve is being affected by swelling or by the fracture itself. In most cases, symptoms improve as the swelling settles, but ongoing or worsening issues might need further tests or review.

Pain is common, especially in the first few weeks. One of the best ways to reduce this is by keeping the wrist elevated above the level of your heart. If your hand hangs down for long periods, fluid collects, causing swelling and pressure – which leads to pain. Elevation is simple but important. You can do this by resting the hand on pillows while sitting or sleeping, or by wearing a sling briefly when walking around.

If swelling becomes severe, the cast may start to feel overly tight. If you notice pins and needles, colour changes in the fingers, or increasing discomfort, you should go to the Emergency Department so we can check the cast and make sure there’s no circulation issue.

Every patient is different, so your treatment plan will depend on factors like your age, activity level, smoking status, and the exact type of fracture seen on X-ray. You’ll get more specific guidance at your fracture clinic appointment, once we’ve reviewed your scans and examined your wrist.

If you’re suitable for non-operative treatment, we’ll arrange a fracture clinic follow-up and repeat X-rays during the first two weeks to check the bone is staying in place. The cast usually stays on for up to six weeks. After that, you’ll start rehab with the hand therapy team.

Most people can return to heavier tasks – like lifting or more physical work – from around ten to twelve weeks after the injury. But even then, the wrist may still feel a bit different. Swelling and soft tissue soreness can continue for a few months, and full recovery is often gradual. With regular rehab and exercises at home, the wrist often keeps improving for up to a year. Grip strength, flexibility, and confidence in the wrist usually improve steadily with use.

If surgery is likely, your case will be discussed at the trauma meeting to make sure the surgical plan is appropriate. The operation is usually scheduled within two weeks of the injury. Most wrist operations are done as day cases – meaning you’ll come in and go home the same day, provided all goes smoothly.

After surgery, your recovery plan may vary slightly depending on what was found during the operation. In some cases, you’ll switch to a removable splint as early as two weeks after surgery. In others, you may stay in a full cast for the full six weeks to allow more protection before rehab begins. The decision depends on the stability of the repair, your lifestyle, and how quickly your wrist is healing.

You’ll normally be reviewed two weeks after surgery to check your wound, assess healing and plan next steps. If your operation involves wires coming out through the skin, those are usually removed in clinic at three to four weeks. Because wires break the skin, they carry a small risk of infection – so let us know if you see any redness, swelling, or discharge around the wire sites. We may prescribe a short course of antibiotics if there are any signs of infection.

Regardless of whether you have surgery or not, you’ll be referred to the hand therapy team. Some patients – especially after surgery – may be able to start light movement exercises earlier, to avoid stiffness. Most people will wait around six weeks before returning to full activities, and heavier tasks are usually added in gradually at ten to twelve weeks.

Recovery continues over time with regular hand therapy and exercises at home. If you stay consistent with your rehab and avoid heavy strain too early, most wrists regain near-normal function in the long term.