Wrist fractures: cast or surgery?

A wrist fracture — usually a break at the end of the radius bone — is one of the most common injuries seen in orthopaedic practice. It typically happens when someone falls onto an outstretched hand. The decision between a cast and surgery depends on the position of the bones, the stability of the fracture, and the patient's activity level.

Not all fractures need an operation. Many wrist fractures are stable, meaning the bone ends are well aligned and unlikely to shift. These can be treated very successfully in a cast or brace for a few weeks.

If the fracture is undisplaced or minimally displaced, and the alignment is acceptable on X-ray, a cast is usually the best treatment. A moulded cast or a lightweight fibreglass splint is applied for 4–6 weeks. Regular X-rays are taken in the first two weeks to make sure the bone has not shifted.

Older patients with low demand can tolerate slightly more displacement than younger, active patients. The goal is not perfect anatomy on X-ray; the goal is a wrist that functions well and is not painful.

Surgery is recommended when the fracture is unstable, severely displaced, or involves the joint surface. Signs of instability include significant shortening, angling, or comminution — where the bone is broken into multiple fragments. These fractures tend to collapse in a cast, leading to poor function and arthritis later.

Surgery usually involves a plate and screws placed through a small incision on the palm side of the wrist. This stabilises the fracture and allows early finger and wrist movement. Recovery still takes several months, but the final position is more predictable.

Whether treated with a cast or surgery, recovery follows a similar path. The wrist is protected while the bone heals, then movement is gradually increased. Physiotherapy may be needed to recover wrist flexion, extension, and grip strength. Most people regain good function, though some stiffness is common for several months.

We follow fractures closely with X-rays and clinical checks. If a fracture treated in a cast starts to shift, we may recommend surgery to reposition it. Early follow-up is therefore essential — do not skip the first appointment after the injury.