Do I need surgery for a broken wrist?

Not always. Fractures that are not displaced, are stable, and don't extend into the wrist joint usually heal well in a cast/brace. Fractures that are displaced, unstable, or break into the joint surface generally do better with surgery, restoring the anatomy gives the best long-term wrist function. Dr. Lee discusses both options honestly and will not push an operation for a fracture that doesn't need one.

What is a volar plate?

A volar plate is a small titanium plate placed on the palm-side surface of the radius to hold the fracture in correct alignment while it heals. Modern volar plates use fixed-angle screws, the screws lock into the plate, which makes the construct stable even in osteoporotic bone.

How long until I can use my hand again?

After surgery, finger motion begins immediately and most patients are typing within a week or two. Light hand use returns by 2–4 weeks. Heavy lifting, gripping, and impact sport are typically deferred until 8–12 weeks. Full bone healing can take 3–4 months.

Will the plate need to be removed later?

Usually not. Modern low-profile volar plates are well-tolerated and most patients keep them indefinitely. Removal is occasionally needed if the plate becomes prominent or irritates the flexor tendons, and is sometimes elected by younger patients who want to avoid metal in their wrist long-term.

Can I get a second opinion on a wrist fracture?

Yes, and many patients do. Dr. Lee sees second-opinion patients regularly, including patients told they need surgery elsewhere and patients told they don't. If you have imaging already, send it ahead and the visit will be substantive.

Distal Radius (Wrist) Fracture, Steven J. Lee, MD

The distal radius, one of two bones at the wrist end of the forearm, is the most commonly fractured bone in the upper extremity. A distal radius fracture (sometimes called a Colles fracture, Smith fracture, or simply a broken wrist) usually happens after a fall onto an outstretched hand.

The fracture pattern can range from a simple crack in the bone to a complex break that extends into the wrist joint. The appropriate treatment depends on how much the bone is displaced and angulated, whether the joint surface is involved, the age and activity level of the patient, and how well the patient can function without surgery.

Anatomy of the wrist

The wrist is formed by the distal ends of the radius and ulna meeting eight small carpal bones. Most of the load across the wrist passes through the radius, which is why the radius is the bone that most often breaks. The wrist works best long term if the distal radius is restored as close to anatomically as possible.

Signs and symptoms

Patients often describe:

Immediate pain and swelling at the wrist after a fall
Visible deformity, a 'dinner fork' shape in classic displaced fractures
Inability to use the hand or rotate the forearm
Bruising that develops over the next 24 hours
Numbness or tingling in the fingers (a sign the median nerve may be compressed by the fracture)
In some non-displaced fractures, these symptoms may not be obvious and patients may just assume that they have a bad sprain

New numbness, severe pain not controlled by ice and elevation, or rapidly worsening swelling are reasons to be seen urgently, these can indicate acute carpal tunnel syndrome or compartment syndrome.

How distal radius fractures are diagnosed

Diagnosis is often made on plain X-rays. MRI's may be obtained if the diagnosis is in question, and CT scans are sometimes added when the fracture extends into the wrist joint and finer detail is needed for surgical planning.

Dr. Lee's approach

Not every distal radius fracture needs surgery. Stable, well-aligned fractures can heal as well without surgery as compared to with surgery. Determining which fracture would benefit from surgery requires years of experience.

When surgery is the right call, the goal is to restore the anatomy as closely as possible to what was there before the fall. Dr. Lee helped design some of the plating systems now used by surgeons around the country, and selects the plate best suited to each fracture.

Non-surgical treatment

Fractures that are minimally displaced, stable, and not involving the joint are managed in a well-molded cast or brace. The brace typically stays on for 5–6 weeks, with X-rays every 1–2 weeks to make sure the fracture is staying in good position. Hand therapy is usually started before the brace comes off.

Surgical treatment, a complete toolbox

When the fracture is displaced, unstable, or extends into the wrist joint, surgery can offer a more reliable path to a normal-functioning wrist. Dr. Lee uses an armamentarium of plates, screws, and pins to help restore the bone as closely to how human nature intended.

The hardware Dr. Lee uses includes systems he helped design. The range includes volar plates, fixed angle screws, bridge plates, cannulated screws, fragment specific plating, and pins. Most patients begin gentle finger and wrist motion within days.

Recovery timeline

Recovery timelines for surgical fixation:

Day 0–7
Splint for the first week. Begin finger range-of-motion immediately to prevent stiffness. Elevation and ice. No sweating for the first week. Most patients are off narcotic pain medication within 2-3 days.
Weeks 1–2
Sutures removed. Transition to a removable wrist brace. Finger range of motion initiated.
Weeks 2–6
Progressive return to daily activities. No lifting more than a coffee cup. Wrist range of motion can often be initiated with the supervision of a hand therapist. Bone is healing but not yet strong.
Weeks 6–12
Strength returns. Splints are weaned off. Most patients return to office work by 2 weeks, manual work by 8–12 weeks, and sport by 3 months. Full bone healing takes 3–4 months.

What patients commonly misunderstand

Three things worth setting straight:

Surgery vs no surgery is not always the obvious call. A cast/splint is the right answer for many fractures and the wrong answer for others. The fracture pattern, displacement, and patient demands all matter, a good surgeon talks through both options honestly.
Wrist stiffness is the most common avoidable problem. Patients who immobilize the fingers and shoulder while the wrist heals end up with stiff hands. Early finger motion and shoulder mobility are important.
The hardware usually stays. Modern low-profile volar plates are well-tolerated and do not need to be removed in most patients. Removal is occasionally needed for irritation or in younger patients.

This page is general educational content authored by Dr. Lee. It is not a substitute for individual medical advice. Every patient's case is different, book a consultation to discuss yours.

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Distal Radius Fracture: the wrist fracture, treated properly.