Distal Radius Fractures

The radius is one of two forearm bones and is located on the thumb side. The part of the radius connected to the wrist joint is called the distal radius. When the radius breaks near the wrist, it is called a distal radius fracture.

The break usually happens due to falling on an outstretched or flexed hand. It can also happen in a car accident, a bike accident, a skiing accident or another sports activity. This type of fracture can significantly affect the patient’s daily activities and quality of life.

A distal radius fracture almost always occurs about 1 inch from the end of the bone. This very common fracture can occur in many different ways to people of all ages. In young people, such fractures typically occur in high-energy accidents, such as a fall from a ladder or a car crash.

In older people, especially those with osteoporosis, distal radius fractures can occur from a simple fall onto the wrist.

Fractures can be classified by their relationship to the joint as intra-articular (involving the joint surface) or extra-articular (not extending into the joint). They can also be classified by the severity of the break or external trauma: an open fracture means the bone protrudes through the skin, while a comminuted fracture is a break where the bone is shattered into more than two pieces. The nature of the injury, such as the direction and force of an impact, ultimately determines the fracture pattern.

Additionally, they can be categorized as stable, where there is simple displacement of the bones, or unstable, where after being repositioned, there is a tendency for the fragments to shift again. Distal radius fractures can also be further distinguished into Colles or Smith fractures, depending on the angle of the distal radius as it breaks.

• A Colles fracture may result from direct impact to the palm, like if you use your hands to break up a fall and land on the palms. The side view of a wrist after a Colles fracture is sometimes compared to the shape of a fork facing down. There is a distinct “bump” in the wrist similar to the neck of the fork. It happens because the broken end of the distal radius shifts up toward the back of the hand.
• A Smith fracture is the less common of the two. It may result from an impact to the back of the wrist, such as falling on a bent wrist. The end of the distal radius typically shifts down toward the palm side in this type of fracture. This usually makes for a distinct drop in the wrist where the longer part of the radius ends.

Finally, the fractures of the distal radius, which affect the wrist joint, can be classified as radial styloid fractures (also known as Chauffeur’s fractures) or Barton fractures, a type of intra-articular distal radius fracture involving a fragment of the articular surface. A dorsal Barton fracture involves the dorsal (back) rim of the radius, while a volar (palmar or front) Barton fracture involves the volar rim, with displacement of the carpal bones along with the fractured fragment.

Distal radius fractures can be caused by a variety of traumatic events or injuries, including:

• Falls: A fall onto an outstretched hand is the most common cause of a distal radius fracture, particularly in older adults.
• Sports injuries: High-impact sports, such as skateboarding, skiing, snowboarding, or contact sports, can also result in a distal radius fracture.
• Car accidents: The impact of a car accident can transmit enough force to the wrist to cause a fracture.
• Work-related injuries: Certain occupations that involve repetitive or high-force movements, such as construction work or manual labor, may increase the risk of a distal radius fracture.
• Osteoporosis: People with osteoporosis, a condition characterized by weakened bones, are at an increased risk of experiencing a distal radius fracture. In fact, women are more prone to these fractures compared to men. This is mainly due to the higher prevalence of osteoporosis in postmenopausal women, which increases the risk of fracture.

The symptoms and associated injuries of a distal radius fracture, one of the most common wrist fractures, which involves a break in the radius bone at the wrist, often accompanied by ulnar fractures or injuries to the radiocarpal and intercarpal ligaments, or to the ligaments of the distal radioulnar joint, resulting in wrist instability.

The main signs and symptoms of a distal radius fracture may include:

• Pain: The most common symptom of a distal radius fracture is pain, which can be moderate to severe.
• Swelling: The wrist may become swollen and tender to the touch.
• Deformity: A visible deformity of the wrist may be present, such as a bump or a visible angulation.
• Limited range of motion: Patients with a distal radius fracture may experience a limited range of motion in the wrist and may have difficulty moving the fingers.
• Numbness or tingling: In some cases, patients may experience numbness or tingling in the fingers or hand.
• Weakness: Weakness in the wrist or hand may also be present.
• Bruising: Bruising or discoloration around the wrist may be present as well.

Distal radius fracture diagnosis involves the following:

Medical History & Physical Examination:

• A thorough history and physical exam are crucial for identifying the injury and associated problems.
• Clinicians assess for pain, tenderness, swelling, bruising, and a “dinner fork” deformity (a classic sign of a displaced fracture).
• Neurovascular status of the extremity (pulses, sensation, and motor function) is paramount.
• Associated injuries to surrounding joints (e.g., the wrist or elbow) are also assessed.

Imaging Tests:

• X-rays: Standard anteroposterior and lateral wrist X-rays are used to confirm the fracture and determine its pattern, displacement, and angulation.
• CT Scan: A Computed Tomography (CT) scan may be beneficial for evaluating complex, comminuted (fragmented), or intra-articular (joint-involving) fractures and for surgical planning.
• MRI Scan: An MRI is generally not for the initial diagnosis but can be used for evaluating potential associated injuries, such as damage to the triangular fibrocartilage complex (TFCC).

Management of distal radius fractures (DRFs) involves a multifactorial decision-making process, balancing fracture characteristics (like displacement, instability, and comminution) with host factors such as patient age, functional demands, and bone quality to determine the most appropriate non-surgical (cast or splint immobilization) or surgical (volar locking plates, percutaneous pinning, or external fixation treatment strategy. The primary goal is to restore wrist mobility, relieve pain, and achieve functional recovery, with treatment tailoring varying significantly between young, active patients and older, frail individuals.

Conservative treatment involves immobilizing the wrist in a cast for 4-6 weeks and is indicated for stable fractures. Closed reduction (repositioning bone fragments by manipulation) under local anesthesia is often performed before casting for fractures with mild displacement.

Surgery is indicated for unstable fractures, severe displacement where closed reduction is not effective, complex fracture patterns, or in young, active patients. It is also necessary if the patient has sensory or motor deficits in the fingers.

Various surgical techniques can be performed, with the appropriate surgical procedure chosen based on the fracture type. The most common technique is Open Reduction and Internal Fixation (ORIF).  This is a common surgical technique to repair distal radius fractures. During this procedure, the bone fragments are re-aligned (reduced) and secured in their correct position using a special anatomical titanium plate and screws and it is typically performed through a small incision on the wrist.

After surgery, early mobilization of the limb is often encouraged, and splinting may not be required.

Whether treated conservatively or surgically, physiotherapy rehabilitation plays a crucial role in the successful recovery of patients with distal radius fractures. The goals of physiotherapy include:

• Pain Management: Addressing and controlling pain in the wrist and hand.
• Restoring Motion: Gradually regaining the full range of motion in the wrist and hand.
• Strengthening: Building strength in the muscles of the wrist and hand.
• Functional Recovery: Helping the patient return to their normal daily activities and functionality.

The Orthopedic Upper Limb Surgeon Dr. Panagiotis Pantos has specialized knowledge and extensive experience in evaluating, managing and effectively rehabilitating numerous distal radius fractures, always choosing the treatment approach that best suits both the fracture type and patient needs.