What is a distal radius fracture?
The distal radius is the end (distal) portion of the forearm bone (radius). It connects to the carpal bones at the wrist and runs parallel to the ulna, which is the other bone of the forearm. The radius transmits up to 80% of the forces across the wrist to the forearm. In traumatic injuries, the distal radius breaks close to or at its joint with the carpal bones of the wrist. These fractures most often occur as the result of a fall on an outstretched wrist. It is the most common type of fracture in the arm.
Who gets a distal radius fracture?
Distal radius fractures are very common in two subsets of patients: children and the middle-aged. They are the most common arm fracture in kids, as they spend a great deal of time at play, which can lead to falls. These fractures are typically non-displaced, or ‘greenstick,’ fractures. At the other end of the age spectrum, middle-aged patients, particularly those with moderate osteoporosis, commonly experience these fractures as the result of falls brought on by instability in gait and balance. Of course, anyone who participates in activates capable of generating enough force to break bones—think contact sports, roller or ice skating, cycling, etc.—can experience a distal radius fracture.
How are distal radius fractures described?
Many distal radius fractures are dorsally displaced due to the nature of the injury (a fall on an outstretched hand). They can be extra-articular—meaning the joint is not involved—or intra-articular, meaning the fractures spread into the wrist joint. Intra-articular fractures have a worse prognosis as they involve fractures of multiple bones, not just the radius.
After a fall, there will often be swelling, pain, and limited motion in the affected wrist. In extreme cases, there can be an obvious, or visible, deformity in the wrist. In any case, X-rays are essential in making the proper diagnosis as they allow the physician to visualize the bone and assess the extent of the trauma. With intra-articular fractures, CT scans are often used to plan surgical treatment as they allow the physician to better understand the fracture patterns in the carpal bones and decide how they will correct those breaks.
How are distal radius fractures treated?
Non-displaced distal radius fractures can be treated in a cast until swelling and pain have subsided. For an adult, a non-displaced distal radius fracture will heal over the course of six to ten weeks. Over the course of healing, frequent x-rays are taken to ensure there has been no significant displacement of the bone as it is healing. A fracture brace can also be used in place of a splint.
Displaced distal radius fractures in children are most often externally reduced and casted. Sometimes the reduction needs to be held in place with an external pin. In either case, the reduction is done under sedation to ensure the patient does not feel pain during the procedure.
Displaced distal radius fractures in adults are usually treated with open reduction and internal fixation. This is most often accomplished with a plate placed on the palm side of the forearm. With stable plate fixation, patients can often go into a removable brace two to four weeks after surgery.
What should you expect if you have a distal radius fracture?
The outcome of your injury largely depends on the nature and severity of the break. The more severe the injury is, the more likely it is that there will be complications during treatment. The second major factor driving outcomes is the post-injury alignment of your wrist. The closer your wrist is aligned to where it was before the injury, the better your outcome will be. Unfortunately, this is not often the case with highly displaced or comminuted fractures, especially if the joint is involved.