Advice after your nerve block for surgery
On this page…
Anatomy of the Wrist
Your wrist bridges your hand to your forearm. It is a complex collection of multiple bones and joints. The two bones of your forearm (your radius and ulna) join with the first of two rows of small bones - the carpal bones. There are eight of these carpal bones and they join with the 5 metacarpal bones in your hand.
The term ‘wrist fracture’ normally refers to a broken bottom end of the radius bone. There is often also a small bit of bone chipped off the tip of the ulna.
Occasionally it is the scaphoid bone (see diagram below) which has broken and not the radius. If this is the case, you will be seen by our Plastic surgeons.
Who gets broken wrists and how do they happen?
Wrist fractures are very common. Children commonly break their wrists when they fall on trampolines, from monkey-bars or off bicycles. In adults below 50 years of age they normally happen after high-energy injuries, such as coming off a motorbike or falling from height. However, as we get older, our bones weaken, so a simple fall onto an outstretched hand can break the wrist in an elderly patient.
Does my wrist fracture need to be fixed?
The majority of broken wrists can be managed without surgery in a plaster cast. The severity of injury can vary widely. The fracture in your wrist may just be a simple crack, or it may have broken into several pieces and be displaced.
If a wrist fracture is displaced, it normally bends backwards, but can sometimes go the other way. As well as bending, the radius bone also shortens. Both of these types of displacement can disrupt the normal function of your wrist. Sometimes this means you need something to be done to improve your functional outcome. If that is the case, your surgeon may recommend an operation to improve your chances of a good functional outcome.
Non-operative management of your wrist fracture
Displaced fractures are usually ‘pulled’ in the Emergency Department under local anaesthetic or sedation. This aims to achieve a good position of the bones and hold them in a cast. For many, this achieves a good enough position of the bones to avoid the need for surgery. If that is the case, you will need to have check x-rays in fracture clinic after a week to ensure the position of your bones has not slipped inside the cast. If it remains good, your cast will be reinforced and you will complete six weeks in plaster. About 10% of patients will need surgery to fix the bones because of slippage at the one-week point.
Non-displaced fractures of distal radius are usually sustained by low-energy injuries and are largely comfortable once the wrist is immobilised. The choice of immobilisation may vary from a cast to a custom-made splint.
Operations for wrist fracture
Depending on your age and your fracture pattern you may require one of three operations. All require anaesthetic – normally a general anaesthetic, but sometimes you remain awake with your arm made numb by a nerve block.
- Manipulation and application of plaster cast: This is a non-invasive procedure where no incision is required. Using x-ray control, your wrist bones are realigned and placed in a cast to allow your bones to heal in a satisfactory position.
- K-wire fixation: In this operation, your wrist is manipulated and smooth metal wires are placed through tiny cuts in your skin into the bone to hold the position while healing occurs. You also have a plaster applied. The wires are removed in clinic at 4 weeks (this is not usually painful).
- Plate fixation: An incision (approx. 7cm long) is made over the palmar side of your forearm to gain access to your broken wrist. The fractured bones are carefully moved back into place and held with a plate and screws that are applied to the surface of your bone. The wound is sutured and a bulky dressing or a plaster cast is applied for a couple of weeks. You can then begin to move your wrist gently and use a removable splint until 6 weeks.
If you require surgery you will need to come into hospital. Often wrist surgery can be done as a day case, but some patients need to stay overnight. You will not be allowed to eat for six hours before your operation, but you can drink clear water until two hours before. It is important to continue your current medication regimen unless told otherwise. Please note that you should NOT take blood thinning medicines, such as Warfarin, Apixiban, Clopidogrel or Aspirin. Our trauma administrator will explain all these things to you and answer any questions you may have.
Caring for your plaster cast
Please don’t get your plaster cast wet
If your cast is plaster of Paris it will disintegrate; and if it’s fibreglass, water will make the padding soggy and your skin will become sore and could break down.
You can purchase waterproof covers online, e.g., from www.
Please don’t poke or push anything inside your plaster
It is easy to scratch or cut your skin when trying to relieve an itch. This can lead to further irritation and infection. If you have any problems with your cast, please contact the Plaster Room.
Advice on removal of your cast
A full cast is removed using an oscillating (vibrating) saw. Once the cast is off, you will notice your skin is flaky and dry. You can soak your arm in warm water for 10 minutes after your cast comes off to remove the dry skin and then use a moisturizer cream. Do not scrub your skin as it will become sore.
Your wrist and hand may swell up after your cast is removed. If this happens, keep your hand raised above heart height as much as possible. This will reduce the swelling. Pain and swelling can be eased by using ice for 5-10 minutes over the wrist area. Wrap the ice in a damp towel to protect your skin. Basic pain killers will also help.
If the pain becomes severe or continuous, we suggest you contact your GP for advice.
You may find your elbow and shoulder joints are stiff too, so keep these moving if they are not injured.
It is important that you start to exercise your arm as soon as your cast is removed. By exercising and regaining normal movements, the feeling of stiffness and pain will gradually subside.
The exercises will be most effective if practiced regularly. We suggest doing the exercises 3-4 times a day. It is better to repeat the exercises a few times every hour, rather than once a day for a longer period.
Driving
You are not able to drive while wearing a plaster cast. Once this has been removed, please seek advice from your surgeon about when you will be able to drive as this is specific to your fracture and operation. The DVLA require you to be ‘confident and competent to control your vehicle during both routine and emergency manoeuvres.’
In general, you can expect it to take a week or two after cast removal to be ready to drive.
Return to work
Return to work time will vary on your injury, your recovery and your occupation. Desk work may be possible after a week or two, but heavy labour will take 2-3 months or even longer in some cases. Your surgeon can guide you on this and issue a sick note if required.
Exercises for your wrist
These simple exercises will help you to restore motion in your wrist. Try to do them regularly (at least twice a day).
 |
Rest forearm on a table with hand over the edge. Bend hand towards the floor and then raise up towards the ceiling. Check that the movement only takes place at the wrist. |
 |
Rest the palm of your hand on the table. Tilt the hand one way and then the other. |
 |
Place your forearm on the table. Turn your palm down, and then up, keeping the elbow still |
 |
Touch your thumb to the tip of each finger. Repeat this as quickly as possible |
  |
Make a tight fist, ensuring your knuckles are bent to a right angle. Use your other hand to help if necessary. Then fully straighten the fingers |
  |
With the palm of your hand facing upwards. Bend the thumb across palm of hand to base of little finger Then stretch out to side as far as possible |
Symptoms and management
Contact the Emergency Department immediately if you experience any of the following
- Extreme or increasing pain since the injury
- Pain in the chest or shortness of breath
- Your fingers become blue and swollen (not bruising, which can be normal following an injury)
Contact the Plaster Room on site if you experience
- ‘Blister like pain’ or rubbing inside the cast
- Numbness or pins and needles in the fingers
- Discharge, wetness or smell under the cast
- Swelling that is not going down even after elevating the limb to above heart level
- If your cast becomes cracked, soft, loose or tight
- If you drop anything inside the cast
Contact details
For queries regarding your cast, contact the Plaster Room Wexham on 0300 6154058 or Plaster Room Frimley 0300 6134339
Contact us
If you have any queries relating to this information, please contact the Orthopaedics service.
About this information
Service:
Orthopaedics
Reference:
N/041
Approval date:
31 July 2025
Review date:
1 July 2028
Click ‘show accessibility tools’ at the bottom of the page
Then click ‘select language’
Alternative formats
You can use the accessibility toolbar at the bottom of your screen to:
-
Change the text size
-
Adjust the font
-
Modify the colour contrast
-
Use the translate function
If you would like this information in another format, such as Braille, audio, or easy read, please speak to a member of staff.
You can also print as well as download as PDF using the “Print this page” button at the end of the page.
Staff will print a copy for you on request
Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.