Wrist fracture - Distal radius

General

 Wrist fractures may affect any of the bones in the wrist.

The most common bone referred to when talking about a wrist fracture is the Distal radius.

This is the larger of the two bones at the end of your forearm on the thumb side, the other bone is the ulna.

 X ray of the wrist to the right

Distal radius shown in purple and distal ulna in yellow. 

Distal radial fractures occur following a fall on the outstretched arm.

Diagnosis

The diagnosis is usually made on the history of the patient falling on a straight outstretched arm and the patient

complaining of pain in the wrist predominantly on the thumb side.

The wrist may look a little deformed and swollen.

X rays are often needed to be sure if it is broken or not.

Mouseover click if you can't see the break 

If the bones have moved a long way out of position it is said to be displaced

A fracture that goes into the joint is called an Intra articular fracture. This is important because it is important to ensure the joint surface is smooth.

When the bone is broken into a number of pieces it is called comminuted or multifragmentary.

If the skin is cut or open it is called an open fracture.

Treatment

Treatment depends on how badly the bone has been broken, the degree of comminution, if it involves the joint surface and if it is open.

Immediate treatment

If the wrist is deformed the arm will often be re aligned (reduced) in the emergency department under sedation or local anaesthetic block.

Undisplaced fractures or fractures that are reduced (set) into a perfect position in the emergency department  are often treated non operatively in a

cast initially.

Displaced fractures or fractures not perfectly set may need to be treated with an operation.

Non operative treatment

A back slab or partial cast is often applied initially for the first week to 10 days to allow for the swelling of the limb.

This backslab is then changed to a full cast at around 7 to 10 days, followed by repeat x rays in the new cast if the fracture was displaced,

comminuted or required a manipulation in the emergency department.

A cast is normally worn for 6 weeks. 

The wrist remains a little achy and tender till about 3 months and will continue to improve over the next 2 years.

Operative treatment

Complex fractures with significant comminution and displacement may require surgery to reduce and hold the bones in a good position.

 The bones can often be reduced by simply pulling and manipulating the wrist.

 Once the bones are reduced into the correct position they need to be held in that position.

 The options to hold the bones in position includes:

•

 Below elbow cast

•

Cast and K wires - Surgical steel wires that are inserted into the wrist

•

Plate and screws

•

External fixator - Frame on the outside of the wrist with pins into the bones

 The final treatment depends on several factors, the patients expectations and future demands, fracture pattern and surgeons experience.

Outcome

The outcome is variable and depends on how bad the fracture was in the first place.

A few generalizations can be made.

Most fractures can be treated with a cast and are healed enough to no longer need a cast by 6 weeks.

Vigorous and sporting activity can be resumed around 3 to 6 months from injury.

Gradual improvement in wrist movement and strength continues for even a year to 18 months from the injury.

Most patients have a little achiness and stiffness after the injury, very few ever require further surgery for long term problems following a distal radial

fracture.