Distal Radius (Wrist) Fracture

Anatomy

Bones of the forearm include the radius and the ulna.

The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the area of the radius near the wrist breaks.

Cause

Distal radius fractures are very common. In fact, the radius is the most commonly broken bone in the arm. The break usually happens when a fall causes someone to land on their outstretched hands. It can also happen in a car accident, a bike accident, a skiing accident, and similar situations.

Sometimes, the other bone of the forearm (the ulna) is also broken. When this happens, it is called a distal ulna fracture.

Symptoms

A broken wrist usually causes immediate pain, tenderness, bruising, and swelling. Frequently, the wrist hangs in an odd or bent way (deformity).

Diagnosis

Your doctor will take an X-ray of the wrist to understand the extent of the injury.

A fracture that extends into the joint, it is called an intra-articular fracture. A fracture that does not extend into the joint is called an extra-articular fracture. ("Articular" means "joint.")

When a bone is broken into more than two pieces, it is called a comminuted fracture.

It is important to classify the type of fracture, because some fractures are more difficult to treat than others. Intra-articular fractures (fractures within the joints), open fractures (fractures that break through the skin), and comminuted fractures (fracture that shatter the bone into a lot of small pieces) are more difficult to treat, for example.

Risk Factors

Osteoporosis (decreased density of the bones) can make a relatively minor fall result in a broken wrist. Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position.

A broken wrist can happen even in healthy bones, if the force of the trauma is severe enough. For example, a car accident or a fall off a bike may generate enough force to break a wrist.

Treatment

Immediate Treatment
If the injury is not very painful and the wrist is not deformed, it may be possible to wait until the next day. The wrist may be protected with a splint. An ice pack can be applied to the wrist and the wrist can be elevated until your doctor is able to examine it.

If the injury is very painful, if the wrist is deformed or numb or the fingers are not pink, it is necessary to go to the emergency room.

Nonsurgical Treatment
There are many treatment choices. The choice depends on many factors, such as the nature of the fracture, age and activity level. The following is a general discussion of the possible options.

Casting: If the broken bone is in a good position, a cast may be applied until the bone heals. If the position (alignment) of your bone is not good and likely to limit the future use of the arm, it may be necessary to correct the deformity. The bone would be re-aligned (reduced).

After the bone is properly aligned, a splint or cast may be placed on your arm. A splint is usually used for the first few days, to allow for a small amount of normal swelling. A cast is usually added a few days to a week or so later, after the swelling goes down. The cast is changed two or three weeks later as the swelling goes down more, causing the cast to loosen. X-rays may be taken at weekly intervals for three weeks and then at six weeks if the fracture was reduced or thought to be unstable. X-rays may be taken less often if the fracture was not reduced and thought to be stable.

The cast is removed about six weeks after the fracture happened. At that point, physical therapy is often started to help improve the motion and function of the injured wrist.

Surgical Treatment
Sometimes, the position of the bone is so much out of place that it cannot be corrected or kept corrected in a cast. This has the potential of interfering with the future functioning of your arm. In this case, surgery may be required.

Depending on the fracture, there are a number of options for holding the bone in the correct position, including a cast, metal pins (usually stainless steel or titanium), a plate and screws, an external fixator (a device for which most of the hardware remains outside of the body), or any combination of these techniques.

After Surgery

Most fractures hurt moderately for a few days to a couple of weeks. Many patients find that using ice, elevation (holding their arm up above their heart), and simple, non-prescription medications for pain relief are all that are needed.

Casts and splints must be kept dry. A plastic bag over the arm while showering should help. If the cast does become wet, it will not dry very easily. A hair dryer on the cool setting may be helpful.

Most surgical incisions must be kept clean and dry for five days or until the sutures (stitches) are removed, whichever occurs later.

Most patients do return to all their former activities. The nature of the injury, the kind of treatment received, and the body's response to the treatment all have an impact, so the answer is different for each individual.

Most patients will start physical therapy, if their doctor feels it is needed, within a few days to weeks after surgery, or right after the last cast is taken off.

Most patients can resume vigorous physical activities, such as skiing or football, between three and six months after the injury.

Almost all patients will have some stiffness in the wrist, which will generally lessen in the month or two after the cast is taken off or after surgery. Improvement will continue for at least two years.

Recovery should be expected to take at least a year. Some pain with vigorous activities may be expected for about that long. Some residual stiffness or ache is to be expected for two years or possibly permanently, especially for high-energy injuries (such as motorcycle crashes, etc), in patients older than 50 years of age, or in patients who have some osteoarthritis. However, the stiffness is usually minor and may not affect the overall function of the arm.