Joint Fractures are usually the result of trauma where the force of a heavy and direct trauma cannot be absorbed or sustained by the muscles and bony structures, causing the bone to break. Often there will be associated soft tissue injury to the surrounding ligaments and muscles. Common joint fractures occur in the arm such as in the wrist, hand and ankle.
What is a wrist fracture?
The most common wrist fracture is to the radius because out of the two forearm bones, it is the one that takes most of your weight (approximately 80%) when you push up using your hand. A fractured ulna is less common.
This injury is usually consequent to falling onto an outstretched hand but can result from a very heavy and direct trauma to your arm. A fractured wrist will be treated with either a cast or surgery, and this depends on the force of the fall or direct trauma which influences the severity and position of the fracture.
How do I know if I have a wrist fracture?
Signs that your wrist may be fractured include pain, swelling and reduced movement. Pain will usually be quite severe indicating that an X-ray is required. It is not uncommon for small hairline fractures to be missed, so if you experience ongoing pain after a fall onto your hand you should seek to have another X-ray.
Children often sustain small fractures that are missed or assumed to be sprains so it is advisable to see your GP or physio if your child has a painful wrist following a heavy blow (eg hockey stick) or a fall on to their hand.
How can physio help my wrist fracture?
Physiotherapists are often involved in fitting fractured wrists with protective splints to keep the wrist immobilised during the healing phase, particularly in children where the bone tends to stay aligned. Immobilising a child’s wrist does not tend to cause stiffness once the cast is removed, but in adults, once the cast or splint is removed the wrist will be stiff, painful and possibly swollen. This is when physio intervention is required to get the wrist moving normally again.
If the fracture occurred at the joint between the two forearm bones, movement is likely to be restricted in the early phases of rehabilitation. Pain and swelling that is experienced after the cast is removed, may be due to ligaments also being injured at the time of the fracture.
It is not always possible for a fractured wrist to heal in perfect alignment which may result in ongoing symptoms that your physiotherapist will manage and treat.
Physiotherapy treatment during the rehab phase will include:
What is a scaphoid fracture?
The scaphoid is the most commonly fractured bone of the carpal bones (the small bones between the forearm bones and the long bones in the hand). As the scaphoid bone is the cornerstone of the wrist it is extremely important that a fractured scaphoid is allowed to heal properly with the correct treatment and the correct amount of time.
Unfortunately, scaphoid fractures can be easily missed at the time of injury because the fracture doesn’t always show up on the first X-ray.
Scaphoid injuries are usually the result of a fall onto an outstretched hand, particularly if you land on the base of the thumb. Often speed and/or height is involved. Usually the wrist is forced too far backwards, but a forceful forward bend of the wrist can also result in a fractured scaphoid.
There are 3 categories of scaphoid fracture, each requiring a different treatment approach to facilitate complete healing. Each part of the scaphoid has a different amount of blood supply which influences how the fracture heals, with one area of the bone, the proximal pole, having a poor blood supply which may compromise healing. Treatment for a scaphoid fracture varies from a cast worn for 6-12 weeks, to surgical fixation of the bone plus a cast.
How do I know if I have a scaphoid fracture?
After sustaining a fall you will probably experience the following symptoms :
It is very important you see your GP or physio for an X-ray referral. If a fracture is not seen at the initial X-ray, a follow-up X-ray is recommended after about 10 days when a fracture will be more visible. You may also be sent for an MRI.
After the initial injury and after the swelling has settled, pain will tend to be more localised to the site of the fracture. Pain around the area where your thumb meets your wrist after a heavy fall, even if the X-ray at the time was clear, may indicate a scaphoid fracture. A 50% grip strength compared to the opposite side, may also be indicative of this fracture.
How can physio help my scaphoid fracture?
Your physiotherapist will manage your scaphoid fracture by:
What is a metacarpal fracture?
The metacarpals are the bones that form the palmar section of the hand. A fracture to a metacarpal can occur at any part of the bone but is most common at the “neck” up near the knuckle. The most commonly fractured metacarpal is the 5th metacarpal that joins up to your little finger. A fracture 5th metacarpal is known as a boxer’s fracture as it is usually caused when punching or hitting with a clenched fist action.
As with any fracture, the severity will depend on the direction, location and amount of force that causes the bone to break. In some instances the bone may need to be put back into alignment under anaesthetic to ensure it heals in the correct position. Fractures that involve the joint require surgical intervention.
How do I know I have a metacarpal fracture?
In most cases you will have immediate pain and swelling at the fracture site but may still be able to move your fingers despite pain. Your finger may look different, pointing in a slightly different direction and look shorter, and the knuckle may seem to have disappeared. There may be a lump in the palm or back of the hand. You can check finger alignment by making a loose fist to see if the fingers are scissoring or crossing over each other.
How can physio help my metacarpal fracture?
Diagnosis will have been confirmed by an X-ray which will indicate whether surgery is required. Where surgery is not indicated the X-ray will guide your physiotherapist’s management and treatment approach, which will include :
What is an ankle fracture?
An ankle fracture involves a break to one of the bones around the ankle joint, usually the tibia or fibula (the long bones in the calf and shin) but may also occur in the talus (the heel). This injury follows a force beyond the capacity of the ankle, such as a severe sprain or a direct blow.
Ankle fractures commonly occur after a severe sprain such as rolling over the ankle but can also result from a fall such as falling down stairs, or after sustaining a direct blow as occurs in a vehicle accident or when kicked. Severity can range from minor incomplete to compound (fragmented) and open fracture, with consequent pain, swelling and limited function of the ankle joint. Those with poor nutrition, low bone density and hormonal deficiencies are at greater risk.
How do I know if I have an ankle fracture?
These injuries are consequent to a significant incident or major trauma and will likely be very painful even at rest and will quickly become swollen. Typically, but not always, you will have difficulty walking after sustaining an ankle fracture. Your physio will assess your injury and if a fracture is indicated, you will be referred for X-ray. If severe ligament injury is suspected you may be referred for an MRI.
How can physio help my ankle fracture?
The first priority is to allow the bones to heal in good alignment which may necessitate a boot or cast and in severe cases may require surgery and fixation. Your physio (in combination with your medical practitioner) will decide on how long you will need to off-load. You may not be allowed to bear weight through the affected leg for a period of time but if the injury is minor, an immobilising boot may be indicated to provide sufficient protection. It generally takes about six weeks for bone healing but in some cases it may take longer.
When the bone has adequately healed you will need to begin rehab and physio treatment to help you return to your usual activities. Your ankle is likely to be stiff and weaker following the period of immobility and you may still experience some pain. Your physio treatment may include mobilisation and/or soft tissue therapy around the ankle to help reduce joint stiffness, along with a strengthening exercise program. When you have made good progress, you will be required to work on higher functions such as running, agility training, jumping and landing if these are indicated.
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