A broken wrist or distal radius fracture is an extremely common type of fracture. It accounts for 25% to 50% of all broken bones and is most commonly seen in older females and young males. The break is typically set and the wrist placed in a cast until the bones have healed. A year or two may be required for complete healing. Most people are able to regain full wrist function.
What is a distal radius fracture?
The forearm is made up of two bones: the radius and the ulna. The radius is the larger of the two and connects the elbow to the "thumb side" of the wrist. The part of the radius near the wrist is called the distal end. A distal radius fracture is therefore the medical term for a broken radius bone near the wrist. In most cases, a "broken wrist" refers to a fractured radius, but it is also possible for both bones in the forearm to be fractured.
Types of Distal Radius Fractures
The most common location for a distal radius fracture is about one inch from the wrist. The break can take place at different angles and unequal amounts of dislocation. The three prominent types of distal radius fractures are:
Colles’ Fracture. This type of fracture moves the radius bone slightly upward and causes obvious deformity. It is most often caused by a direct shock to the palm, like if the hand is used to break up a fall. This break results in a complete fracture of the radius but the wrist joint remains unaffected. Colles’ Fracture represents about 90% of all distal radius fractures.
Smith's Fracture. This is almost always caused by a strike or collision to the back of the wrist, as expected when falling backward or on a bent wrist. The end of the radius is displaced or angled in the direction of the palm of the hand. It accounts for about 5% of all radial and ulnar fractures combined.
Barton’s Fracture. The most common cause of this fracture is a fall on an outstretched wrist. It is a compression injury that extends well into the wrist joint. An MRI is often needed to rule out any damage to the ligaments or soft tissues at the wrist.
What Are the Causes of a Distal Radius Fracture?
The most commonly observed cause of a distal radius fracture is some form of trauma or injury to the wrist. This may be caused by a fall, a vehicular accident, or a sports injury.
The other major risk factor for a distal radius fracture is osteoporosis. "Osteoporosis" literally translates to "porous bone." It is a medical condition that weakens the bones in the body, making them especially fragile and prone to fractures. Osteoporosis most commonly affects older adults, with females being at a higher risk than men. Many distal radius fractures in people over age 60 occur because of a fall.
Even healthy bones near the wrist can suffer from a fracture if the force of impact is severe enough. However, good bone health is a fundamental prevention strategy for distal radius fractures.
What Are the Symptoms of a Distal Radius Fracture?
The most obvious distal radius fracture symptoms are immediate pain and tenderness at the wrist. You may also see significant swelling and bruising. In some cases, the wrist may be deformed or bent/twisted in an odd position.
If the injury is not causing too much pain and the wrist is not bent or crooked, it is possible to wait until the next day to see a doctor. However, going to the emergency room is necessary for most people.
How Is a Distal Radius Fracture Diagnosed?
The doctor will need x-rays of the wrist to confirm the distal radius fracture diagnosis. Detailed x-rays also help doctors determine the severity of the dislocation, the angle of the break, and if any of the surrounding bones are affected.
What Is the Treatment for a Distal Radius Fracture?
There are non-surgical and surgical treatments for distal radius fractures, depending on the severity of the break, potential nerve injury, joint involvement, and the person’s age and activity levels:
If the fractured bone is only slightly misaligned, a simple plaster cast is sufficient for treatment. This cast remains applied until the wrist heals. If the bone fragments are sharply out of place, the doctor will need to re-align them to ensure proper healing. The technical term for moving broken bones into place is "reduction." In most cases, the doctor will be able to straighten the bone without having to make a cut into the skin. This is called a "closed reduction".
Generally, a splint is used on the wrist for the first few days after the fracture. This allows for a bit of swelling that occurs immediately after the injury. After a few days or a week, a plaster cast is added to prevent bone movement. The cast is changed every 2 to 3 weeks as it loosens because of a decrease in swelling. The cast is normally removed about 6 weeks after the fracture. At this point, the bone is healed but physical therapy may be necessary to restore full motion and function.
Sometimes, the displacement of the broken bone is so large that it cannot be corrected by a cast. In this case, an incision into the skin is required to align the bones internally. This "open reduction" method is generally used together with internal fixation tools like metal pins, plates, and screws. A temporary external fixator may also be necessary if there is extensive damage to the tissues around the wrist.
What Is Recovery and Rehabilitation?
Fractures can hurt for a few days or weeks, depending on the extent of the injury. Over-the-counter pain relief medications are usually effective at managing the pain. Ibuprofen and acetaminophen may be prescribed to relieve inflammation at the wrist. Elevating the wrist up above the heart and applying ice packs can also help soothe the pain.
Nearly all patients experience some stiffness and ache in the wrist even after treatment. This usually subsides about a month or two after the cast is removed. In case of severe trauma, like that caused by a motorcycle crash, some residual stiffness can remain for about 2 years or even permanently.
Full distal radius fracture recovery generally takes about a year.