Distal Radius Fractures (Broken Wrist)

Patient Information

Overview

Distal radius is in fact the most commonly broken bone in the arm. It is the end region (near the wrist) of the radius, the larger of the two bones of the forearm.

Description

A distal radius fracture most frequently occurs about 1 inch from the end of the bone.

Below are ways the distal radius can break:

• • Colles fracture: the most common type of fracture where the broken fragment of the radius tilts upward (as seen in picture)
  • Intra-articular fracture: a fracture that extends into the wrist joint
  • Extra-articular fracture: a fracture that does not extend into the joint
  • Open fracture: when a fractured bone breaks the skin. These types of fractures require immediate medical attention to prevent infection.
  • Comminuted fracture: when a bone is broken into more than two pieces
  • Displaced fracture: when the broken pieces of the bone do not line up straight

It is critical to classify the type of fracture as some are more difficult to treat than others. For instance, intra-articular fractures, open fractures, comminuted fractures, and displaced fractures are more difficult to treat. Sometimes, patient may also have a distal ulna fracture on the other bone of the forearm.

Cause

Common causes include:

• • A distal radius fracture is most commonly caused by a fall onto an outstretched arm.
  • Osteoporosis can make a relatively minor fall result in a broken wrist due to the predisposed low bone density.
  • Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position.
  • Traumatic force, such as a car accident or falling off a bike, can cause a broken wrist even in healthy bones.

Symptoms

Symptoms of a broken wrist include:

• • Immediate pain following impact
  • Tenderness
  • Bruising
  • Swelling
  • The wrist hangs in an odd or bent way

Doctor Examination

If you do not experience severe pain and the wrist is not deformed, it may be possible to wait until the next day to see a doctor. In the meantime, you may apply an ice pack to the wrist and keep it elevated until your doctor appointment. You may also wear a splint to protect your wrist.

You should visit the emergency room immediately if the injury is very painful, if the wrist is deformed or numb, or the fingers are not pink.

To confirm the diagnosis, the doctor will order x-rays of the wrist to confirm if the bone is broken, whether there is a displacement, and how many fragment pieces are there.

Treatment

The goal or a bone fracture treatment is to put all the broken pieces back into position and prevent them from moving out of place until they are healed. As there are many different types of fracture, there are many treatment options for a distal radius fracture. Your doctor will determine the best treatment for you depending on the nature the fracture, your age and activity level, as well as the surgeon’s personal preferences.

Nonsurgical Treatment

• • If the broken bone is in a good position, a plaster cast may be applied until the bone heals.

• • If the position of your bone is out of place and likely to limit your arm’s functionality, your doctor may perform a closed reduction. Where he/she will re-align the broken pieces back into place without surgery. Typically, your arm will be placed in a splint for the first few days to a week to allow a small amount of swelling to subside. Then you will be placed in a cast that will be changed after 2 or 3 weeks as the swelling further reduces and the cast becomes loose. Your doctor will closely monitor the fracture with x-rays as often as needed depending on the degree of the fracture. Usually the cast is removed after 6 weeks and you will start physical therapy to help improve motion and function of the wrist.

Surgical Treatment

Surgery may be required when the fracture results in bone deformity that may interfere with future use of the hand and cannot be corrected with a cast or closed reduction.

Procedure: An open reduction surgery may be performed to allow direct access to re-align the broken bones. Depending on the fracture, there are a few options to hold the bone in the correct position while it heals:

• • Cast
  • Metal pins (usually stainless steel or titanium)
  • Plate and screws
  • External fixator (a stabilizing frame outside the body that holds the bones in the proper position so they can heal)
  • Any combination of these techniques

Open fractures: Surgery is required as soon as possible (within 8 hours after injury) in all open fractures. The exposed soft tissue and bone must be thoroughly cleaned, and antibiotics may be given to prevent infection. If the soft tissues are severely damaged, your doctor may apply a temporary external fixator before performing an internal fixation with plates or screws several days later.

Recovery

Recovery is varied for each individual depending on the degree of distal radius fracture and the treatments one received. It is best to follow your doctor’s post-operative instruction and recovery guideline.

Below is the general recovery outlook:

1. Pain Management

Most fractures hurt moderately for the first few days to a couple of weeks. Many patients find comfort in using ice, elevation, and over the counter (OTC) analgesic medications, such as ibuprofen or acetaminophen, to relieve pain. If you experience severe pain not relieved with nonprescription drugs, your doctor may prescribe a narcotic pain reliever that must be taken strictly as directed.

2. Cast and Wound Care

Surgical incisions must be kept dry and clean until the sutures are removed. As mentioned in the “nonsurgical treatment” section, your arm may be placed in a cast that is changed every 2-3 weeks and is usually removed after 6 weeks. During that period, the casts or splints must be kept dry. You may place a plastic bag over your injured arm while showering to help keep it dry. If it gets wet, it will not dry easily and will need to be blow dried with cool air.

3. Potential Complications

Soon after surgery or casting, you should gain full motion of your fingers. If you are unable to fully move your fingers within 24 hours due to pain and/or swelling, contact your doctor for evaluation. Your doctor may adjust the cast or surgical dressing to resolve this issue. Also contact your doctor if you experience unrelenting pain as it may be a sign of Complex Regional Pain Syndrome, which needs aggressive treatment with medications or nerve blocks.

4. Rehabilitation and Return to Activity

Most people eventually return to their formal level of activity. However, recovery is different for each individual due to many factors involved, such as the nature of the injury, the kind of treatment received, and the body’s response to treatment. Stiffness in the wrist is commonly expected and will lessen in a month or two after the cast is removed, and performance continues to improve for at least 2 years. Your doctor may also recommend physical therapy if necessary.

General recovery timeline after treatment:

• • 1-2 months later: resume light activities, such as swimming or lower body exercise
  • 3-6 months after: resume vigorous activities, such as skiing or football

Long-Term Outcomes

Follow your doctor’s instruction carefully will provide the best outcome. However, minor residual stiffness or ache may be experience for 2 years or possibly permanent in those who suffer from high-energy injuries (such as motorcycle crashes), patients above 50 years of age, or patients with osteoarthritis. Usually these symptoms do not interfere with the overall function of the arm. Typically, full recovery should be expected to take at least a year.

References:

OrthoInfo. (2020). Distal radius fractures: Broken wrist. Retried from https://orthoinfo.aaos.org/en/diseases–conditions/distal-radius-fractures-broken-wrist/in-management/cubital-radial-tunnel-syndrome#3