Distal Radius Fracture

The radius is one of the two long bones in the forearm, extending from the elbow to the wrist. It runs parallel to the ulna, the other long bone in the forearm, and connects to the wrist at its "distal" end. Distal radius fractures, which might be known as a “wrist fracture” or “broken wrist”, occur when this part of the bone breaks, typically due to various causes such as a fall onto an outstretched hand, a car accident, sports injuries, or other high-impact incidents. These fractures are quite common, accounting for a significant number of wrist injuries, and can cause considerable pain, swelling, and limited range of motion in the affected area.

Risk factors for distal radius fractures include advanced age, osteoporosis, participation in high-impact sports, and previous history of wrist injuries. When a distal radius fracture occurs, the patient may experience immediate pain, tenderness, swelling, and difficulty moving the wrist. In some cases, the wrist may also appear deformed.

A thorough evaluation is crucial for determining the best course of action for treating a distal radius fracture. When you visit the emergency department or your healthcare provider for a suspected distal radius fracture, they will perform the following steps:

1. Medical history: The doctor will ask about the circumstances of the injury, any previous wrist injuries, and your general health.

2. Physical examination: The doctor will examine your wrist for signs of deformity, swelling, tenderness, decreased range of motion, and nerve compression or injury. He or she also will evaluate for signs of any additional injuries.

3. Imaging studies: X-rays are the standard imaging test for diagnosing distal radius fractures. They provide a clear view of the bone structure and help determine the extent of the injury. In some cases, a CT scan may be necessary for a more detailed assessment, especially if the fracture is complex or involves the wrist joint.

There are different types of distal radius fractures, classified based on the position and severity of the break:

1. Non-displaced: The broken bone fragments have not shifted out of place and remain aligned. Sometimes these are known as Colles’ or Smith’s fractures.

2. Displaced: The broken bone fragments have shifted out of alignment, which may require manipulation to restore proper positioning.

3. Comminuted: The bone is broken into multiple pieces, making treatment more challenging.

4. Intra-articular: The broken bone fragments enter the wrist joint. This disrupts the cartilage that forms the joint surface. These fractures can be more complex and may be more likely to require surgery due to the risk of problems with the wrist joint. Sometimes these are known as Barton’s fractures or chauffeur fractures depending on the specific fracture pattern.

5. Open fractures: The broken bone fragments pierce the skin, increasing the risk of infection and requiring urgent care.

Based on these factors, a doctor may attempt a "reduction" in the emergency department or the clinic to push the bone fragments back into place. A splint or temporary cast will then be applied to support your wrist during the initial healing process.

The treatment for a distal radius fracture depends on the fracture pattern, displacement, stability, and involvement of the wrist joint. Your surgeon will discuss your options and recommend the most suitable approach. There are two primary treatment options:

1. Non-operative treatment: For stable fractures or those with minimal displacement, a non-operative approach may be suitable. This involves wearing a cast or splint for about 6 weeks to immobilize the wrist and allow the bone to heal naturally. Your surgeon will monitor the healing progress with periodic X-rays and may adjust the treatment plan as necessary.

2. Operative treatment: Surgery may be required for fractures with significant displacement, instability, or involvement of the wrist joint. Different surgical techniques can be used to reposition the bone fragments and restore proper alignment. These include:

   a. Open reduction and internal fixation (ORIF): This is the most common surgical method, which involves making an incision to expose the fracture, “reducing” or moving the fragments of bone back into appropriate position, and using metal plates, screws, and pins to secure the bone fragments in place. This technique often results in the greatest stability of the fracture.

   b. Percutaneous pinning: This involves inserting thin metal pins through the skin and into the fractured bone fragments to hold them in place. This technique is typically used for less complicated fractures.

   c. External fixation: This uses an external frame to stabilize the fracture. Pins are inserted through the skin and into the bone and then attached to the frame outside the body. Due to more advanced techniques and implant technology, this previously common technique of external fixation and use rarely now only in very specific circumstances.

Your surgeon will discuss the advantages and disadvantages of each method, taking into account factors such as your age, overall health, and the complexity of the fracture.

Other considerations in your treatment should include:

1. Treatment of additional injuries including:
   a. ulna styloid fractures
   b. fractures of other bones in the hand and wrist
   c. injuries to the TFCC, an important stabilizer of the wrist
   d. injuries to the scapholunate ligament, an important stabilizer of the hand and wrist

2. Treatment of any nerve injury, including injury to the median nerve that may result in an acute carpal tunnel syndrome that may require surgical release at the same time as surgery for the distal radius fracture

Recovering from a distal radius fracture is a gradual process that requires patience and commitment. The recovery timeline and specific steps depend on the severity of the injury and the chosen treatment method. Here's what to expect during the recovery process:

Pain management: Your surgeon will recommend appropriate pain medication to help manage discomfort during the initial healing phase. Our goal is to minimize the need for narcotics with adjunctive pain medications but often narcotic pain medications such as oxycodone are needed after surgery (if performed).

Immobilization: Whether you've undergone surgery or not, your wrist will be immobilized for a period to allow the bone to heal. This typically involves wearing a cast or splint for 6 to 8 weeks, although this duration may be shorter if surgery is performed.

Physical therapy: Once your surgeon determines that the bone has healed sufficiently, you may begin hand therapy to regain strength, flexibility, and range of motion in your wrist and hand. The duration and frequency of therapy sessions will depend on your specific needs and progress. Sometimes this therapy may be performed on your own. Other times, it will be performed with a hand therapy specialist.

Gradual return to activities: As you regain function in your wrist, you'll be able to gradually resume normal activities. However, it's essential to follow your healthcare provider's recommendations and avoid overloading the wrist until it's fully healed. This often requires 3 months or more before returning to full weight bearing activities.

Follow-up care: Your surgeon will schedule follow-up appointments to monitor your progress and ensure that the bone is healing correctly. Additional X-rays may be taken to assess the healing process.

Potential complications during recovery may include stiffness, soreness, infection, or arthritis in the wrist joint. In some cases, additional surgery may be required to address these issues. However, with proper care and rehabilitation, most patients can expect a successful recovery and return to their regular activities.

Be sure to see an experienced surgeon to treat this condition. Our fellowship-trained specialists at The Buncke Clinic in San Francisco treat patients with distal radius fractures from across the Bay Area and Northern California. Contact us to schedule a consultation.

Below are links for third party resources

American Society for Surgery of the Hand

American Academy of Orthopaedic Surgeons