A suspected broken wrist: a case-based approach

The case: a fall onto an outstretched hand

A 40-year-old slips on a wet path and instinctively puts out a hand to break the fall, landing on the palm. Straight away the wrist hurts, begins to swell, and feels weak. Over the next hour it becomes painful to move and hard to grip a mug. This mechanism, known as a fall on an outstretched hand, drives the force up through the wrist and is a classic way to break one of the forearm bones near the wrist or a small wrist bone. It can also simply sprain the ligaments. The problem is that a bad sprain and a fracture can look very similar at first, which is exactly why a careful assessment matters rather than guessing at home.

Sprain or fracture? How clinicians decide

A clinician starts by asking how the injury happened and then gently examines the wrist. They look at where the pain is worst, whether there is bruising, swelling or an obvious deformity, and how well the fingers move and feel. Tenderness directly over a bone, pain on gently loading the wrist, or an inability to grip or bear weight all raise concern for a fracture. They also check the pulse, warmth, colour and sensation in the hand to make sure blood supply and nerves are intact. Because bruising and swelling occur in both sprains and breaks, examination alone cannot always be certain. When a fracture is a realistic possibility, an X-ray is the usual next step to see the bones clearly.

Why an X-ray is often needed

An X-ray is a quick, painless scan that shows the bones and reveals most fractures, including how the pieces are lined up. For wrist injuries after a fall, it helps confirm whether a bone is broken, which bone is involved, and whether it has moved out of position. This matters because the treatment differs: a simple sprain needs support and time, while a fracture may need a plaster cast, a splint, or occasionally an operation to hold the bones correctly while they heal. One small wrist bone, the scaphoid, can be broken yet look normal on an early X-ray, so clinicians sometimes treat the wrist as a fracture and re-check it later. This cautious approach avoids missing a break that could otherwise heal poorly.

Care while the wrist recovers

For a sprain, the early aim is to settle pain and swelling and protect the joint. Familiar first-aid steps help: rest the wrist, apply a cold pack wrapped in a cloth for short spells, gently support it, and keep the hand raised when you can. Simple over-the-counter pain relief, used as directed, makes movement more comfortable. As pain eases, gentle movement helps prevent stiffness. A confirmed fracture is managed by the hospital or fracture clinic, often with a cast or splint for several weeks, and follow-up to check healing. Whatever the diagnosis, avoid heavy gripping and lifting until advised, and follow the guidance you are given. If pain, swelling or bruising worsens rather than settling over a few days, seek review.

Red flags that need urgent care

Some features mean you should not wait. Phone 999 or go to an emergency department if the wrist or forearm looks clearly bent or deformed, if a bone is visible through the skin, or if the hand becomes pale, blue, cold, numb, or you cannot move the fingers, as this can signal harm to blood vessels or nerves. Severe pain that is not controlled, rapidly increasing swelling, or a wound over the injury also need urgent assessment. For less dramatic injuries that are still painful, cannot bear weight, or are not improving, an urgent treatment centre, minor injuries unit or NHS 111 can advise. When in doubt after a fall, it is always safer to have the wrist checked than to assume it is only a sprain.