Distal Radius Wrist Fractures

Accounting for approximately 25% of all bone fractures in children and 18% of all fractures in the elderly, distal radius fractures (commonly known as wrist fractures) are prevalent across all age groups and one of the most common injuries treated by our surgeons at Modern Orthopaedics of New Jersey.

If you suspect you may have broken your wrist or are experiencing pain, swelling, tenderness, bruising, or deformity at or above your wrist, seek immediate medical attention. The information below provides an overview of distal radius fractures including their causes and symptoms, diagnosis, treatment, and what to expect in terms of rehabilitation and recovery:

Understanding Distal Radius Fractures

A distal radius fracture, also commonly known as a wrist fracture, is an injury that occurs when the radius (the long bone on the thumb side of the forearm), fractures close to the wrist joint (frequently, about one inch above it). Depending on the energy and mechanism of injury, a wide variety of different fracture patterns may occur, the two most common being:

• a Colles fracture (typically caused by a fall onto an outstretched arm with the hand flexed back).
• a Smith fracture (typically caused by a fall where the hand is flexed forward under the wrist).

More serious types of distal radius fractures include intra articular fractures (where the fracture extends into the wrist joint), comminuted fractures (where the bone is broken into three or more pieces), and open fractures (where the bone has broken through the skin).

Etiology and Epidemiology

Causes of Distal Radius Fractures

The most common cause of distal radius fracture is a fall onto an outstretched arm.

In patients with healthy bones, such an injury may result from a high-impact incident, such as a fall from a height, a car accident, or a sporting accident.

In older patients, especially where Osteoporosis may be a significant contributing factor, the injury is often also caused by lower energy falls (such as from a standing, or even seated, position).

Prevalence and Risk Groups

Distal radius fractures are the most prevalent type of upper extremity fracture in nearly all age groups. That being said, the injury is notably prevalent in children under 18 years of age and adults over the age of 50. Peak incidence for children is between ages 12 and 14 for males and ages 10 and 12 for females. In many cases, distal radius fractures occur alongside other types of fractures and injuries. Those with weak or brittle bones are particularly at risk.

Symptoms and Clinical Presentation

Because distal radius fractures are usually caused by a traumatic injury, patients often suspect they have broken their wrist upon arrival at our clinic. Common symptoms of distal radius fracture include:

• Immediate pain and tenderness
• Swelling
• Bruising
• Deformity (the wrist is visibly misshapen)
• Loss of motion
• Decreased sensation or numbness in the fingers (this may indicate a severe fracture and should be immediately addressed to mitigate the risk of permanent nerve damage)

Diagnosing Distal Radius Fractures

Physical Examination and History

Your doctor will begin the diagnostic process by taking your medical history. They will ask you to describe how the injury occurred and the sensations you are experiencing, as well as gather information about your overall health and any medications you may currently be taking.

Next, they will conduct a physical examination of your injury to determine whether or not further diagnostic testing is necessary. They may also check the area around the injury as well as other body parts to ensure no other injuries have occurred.

Imaging and Classification

If a distal radius fracture is suspected, an X-ray of the area will be ordered. If the X-ray image reveals a complex fracture that may require surgical treatment, or if your surgeon feels that more comprehensive information is necessary in order to make a conclusive diagnosis, a CT scan or other diagnostic imaging may also be ordered.

Once your surgeon feels confident that they have obtained a clear understanding of your injury, they will classify the fracture pattern and proceed with a personalized treatment plan, based on your specific needs.

Treatment Options for Distal Radius Fractures

No matter the severity of the injury, treating a distal radius fracture typically involves three main steps:

• Restoring the bone to its proper alignment
• Ensuring a smooth joint surface
• Providing stability until the bone heals

Non-Surgical Treatments

Not all distal radius fractures require surgical treatment. In fact, in simple, straightforward cases, non-surgical treatments are often the preferred approach.

Reduction and Casting

Restoring normal alignment is not always necessary for excellent function and patient satisfaction following healing.  There are many factors that play into the decision making for what alignment is deemed acceptable such as age, hand dominance, occupation, other medical issues, etc.  Children can often straighten out bones as they continue to grow.  Elderly patients have been shown to often have excellent function even when the bones are out of place.  Our doctors will discuss these factors and assess what is best for you.

Reduction refers to the realignment of bone fragments that were displaced at the time of injury (a displaced fracture is a fracture where bone pieces have become misaligned). A closed reduction is a reduction that can be performed manually, usually under local anesthesia, without having to make an incision.

If you sustained a nondisplaced fracture (a fracture where your bone did not become misaligned) or your doctor feels that a closed reduction procedure will be effective for your injury, you will likely follow a non-surgical treatment plan. Once your bones have been aligned and swelling has decreased, your arm will be casted to stabilize the fracture, ensuring proper healing and a return to full arm and wrist function.

X-rays or other images of your radius may be taken periodically throughout the recovery process to ensure that your bones remain properly aligned as they heal.

Surgical Treatments

A fracture that is significantly displaced, comminuted, or intraarticular may require surgical fixation.

Internal and Percutaneous Fixation

The two most common surgical procedures for treating distal radius fractures are:

• Open Reduction and Internal Fixation (ORIF) – This surgery involves opening the arm through an incision over the injury and anatomically realigning the bone with a plate and screws to hold the pieces in place. In some cases, particularly in adolescents, removable pins may be used instead.
• Closed Reduction Percutaneous Pinning (CRPP) – This procedure involves the placement of one or more pins without creating a large incision. It is well-suited to cases where just a little extra stability is required before splinting or casting.

External Fixation and Biologics

External fixation (a technique that uses an external frame to stabilize pins placed through the fracture) and biologics (biological agents that enhance and promote bone healing) are less common approaches that may be recommended by your surgeon under specific circumstances. Speak with your surgeon directly for more information.

Recovery and Rehabilitation

Once your distal radius fracture has been realigned and stabilized, recovery and rehabilitation can begin.

Postoperative Care

After surgery, it is crucial to follow your surgeon’s instructions carefully to ensure proper healing.

Cast and Wound Care

During the first two weeks after recovery, it is critical to keep your splint or cast clean and dry. Finger range of motion is encouraged as is frequent rest and elevation of the arm.

Your surgeon will advise you on when and how to remove your bandage and how to care for your incision. In most cases, wounds must be kept dry for about five days post surgery.

Pain Management

Depending on your level of pain, your surgeon may recommend over-the-counter pain relief or write you a prescription for pain medication. Be sure to take pain medication only as prescribed.

Rehabilitation and Return to Activity

Your recovery time after a distal radius fracture will depend on many factors including your age, overall health, the severity of your injury, and your commitment to regaining wrist range of motion (physical therapy exercises are recommended).

Most patients are able to return to light activities one to two months after surgery or cast removal and more vigorous activities three to six months after surgery or cast removal.

Long-Term Outcomes

Full recovery after a distal radius fracture usually takes one to two years, depending on the severity of the injury. While some residual stiffness may remain for certain patients, most patients are able to fully resume all activities after this type of injury.

Individualized Treatment Planning

At Modern Orthopaedics of New Jersey, our award-winning surgical team takes an individualized approach to every distal radius fracture. We recognize that each patient’s unique needs impact the treatment and rehabilitation process and we’re here to guide and support you every step of the way.

To book an appointment, contact Modern Orthopaedics of New Jersey today!