A fracture is a break in a bone. A fractured wrist will be either a Colles' fracture or a scaphoid bone fracture. The scaphoid (one of eight carpal bones in the wrist) is the one most often fractured.

The usual cause of a wrist fracture is a fall on an outstretched arm with an extended wrist.

The Colles' fracture displays dorsal swelling; pain; and a deformity displacement of the hand and wrist. The scaphoid fracture is harder to visualize because it is completely intra-articular, surrounded by cartilage, and has a limited blood supply. The patient usually complains of wrist pain and tenderness in the area between the base of the thumb and the forefinger (this is called the "snuff box" area).

X-rays are taken, and then repeated at 2- to 3-week intervals to make sure that the fracture has not been displaced.

If a fracture is not displaced, then a long-arm thumb spica cast is applied. Displaced fractures will be treated surgically with either internal fixation or external fixation techniques, and application of a cast for six weeks.

Finger flexion exercises should be performed even when the cast is in place. Physical therapy will be needed after cast removal, and it may be 3 to 6 months before a return to full activity is possible. Some people may be able to return to work in 8 to 10 weeks.

• Where service connection (SC) of a fracture or fracture residuals is claimed, SC will be established when sufficient evidence, such as x-rays, a surgical report, casting, or a physical evaluation board report, documents the fracture. If SC of a fracture has not been claimed and objective evidence such as x-ray report documents an in-service fracture, invite a claim for SC for the fracture.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• To properly rate disability, accurate measurement of wrist movement range of motion is required and must be reported in degrees. The use of a goniometer in the measurement of ranges of wrist flexion, wrist extension, wrist abduction, and wrist adduction is indispensable. 38 CFR 4.46 [Accurate measurement]

• Impairments of the elbow, forearm, and wrist will be assigned separate disability evaluations.  The motions of these joints are all viewed as clinically separate and distinct.  Assign separate evaluations for impairment under the following DCs:

  • elbow: flexion under 38 CFR 4.71a, DC 5206, or extension under 38 CFR 4.71a, DC 5207

  • forearm supination and pronation under 38 CFR 4.71a, DC 5213, and

  • wrist flexion or ankylosis under 38 CFR 4.71a, DC 5214 or 38 CFR 4.71a, DC 5215.   

• 38 CFR 4.59 may be applied separately to the elbow, the forearm, and the wrist to result in potentially three separate evaluations for painful motion when the evidence otherwise supports such a finding.  However, 38 CFR 4.59 may only be applied once to the elbow and may not be separately applied to both elbow flexion and elbow extension.

• When examination or other evidence denotes pain present in the joint or periarticular region but does not delineate the specific motions in which pain is present and there is a potential for a separate evaluation under 38 CFR 4.59, obtain a medical opinion to determine which motions are painful. When the examiner cannot delineate which motions are associated with pain, resolve doubt in favor of the Veteran, per 38 CFR 4.3, and consider painful motion to be present in the separate plane such as to allow assignment of the separate minimum compensable evaluation under 38 CFR 4.59.

• None.