Distal Radius Fracture

What is a distal radius fracture?

A distal radius is a fracture / break in the part of the radius bone located near the wrist. The radius is one of the two bones in the forearm, and the distal part refers to the end of the bone closest to the wrist. These fractures often occur due to a fall on an outstretched hand, especially when the impact is taken by the wrist.

Anatomy of the Wrist: Distal Radius

The distal end of the radius bone is at the wrist joint. The wrist joint is made up of:

• Radius:  There are 2 bones in the forearm. The radius is the larger of the bones and is located on the thumb side.
• Ulna: The smaller forearm bone, located on the pinky side.
• Carpal bones: A cluster of eight small bones that make up the wrist.

The distal radius articulates with two carpal bones, the scaphoid and lunate, forming part of the radiocarpal joint, which allows wrist movement.

How Common Are Distal Radius Fractures?

Distal radius fractures are very common fractures, especially in two groups:

• Older adults: This is due to weaker bones, particularly in those with osteoporosis.
• Younger people: Often occur during high-energy trauma like sports injuries or car accidents.

They account for about 17.5% of all fractures seen in emergency departments. Women, particularly post-menopausal, are more prone to this type of fracture because of the increased risk of osteoporosis.

Types of Distal Radius Fractures

The major types of distal radius fractures are classified based on where the fracture is and the direction of the fracture, as well as whether the joint surface is involved. These include:

1. Colles Fracture

• Description: The most common type of distal radius fracture is where the broken fragment of the radius tilts upward (dorsally).
• Mechanism: Often caused by a fall on an outstretched hand (FOOSH).

2. Smith’s Fracture (Reverse Colles Fracture)

• Description: The broken fragment of the radius tilts downward (volarly), opposite to a Colles fracture.
• Mechanism: This usually occurs from a fall on a flexed wrist.

3. Barton’s Fracture

• Description: A fracture-dislocation of the wrist joint (intra-articular) involving both the distal radius and the radiocarpal joint. It can be either:
  • Dorsal Barton’s (displacement towards the back of the hand).
  • Volar Barton’s (displacement towards the palm).
• Mechanism: Caused by high-energy trauma, often in a fall or car accident.

4. Chauffeur’s Fracture (Radial Styloid Fracture)

• Description: A fracture of the radial styloid process, the bony projection on the thumb side of the wrist.
• Mechanism: Often caused by a direct blow or high-energy trauma that forces the wrist into ulnar deviation.

5. Intra-articular vs. Extra-articular Fractures

• Intra-articular fractures: The break extends into the wrist joint, involving the articular surface.
• Extra-articular fractures: The fracture does not affect the joint surface.

 These types vary in severity, treatment options, and recovery times, depending on factors like displacement, joint involvement, and associated soft tissue injuries.

Symptoms and Causes

What causes distal radius fractures?

Distal radius fractures typically occur when a high force is applied to the wrist, causing the distal part of the radius bone to break. These fractures are most commonly caused by:

• Falls: The most common cause, especially falls onto an outstretched hand (FOOSH).
• Sports Injuries: High-impact sports like skiing, snowboarding, biking, and contact sports can cause this fracture.
• Trauma: High-energy trauma such as car accidents, motorcycle crashes, or falls from a significant height.
• Osteoporosis: In older adults, weak bones due to osteoporosis can lead to fractures even with low-energy trauma, like a simple fall.

Common Injury Mechanisms

FOOSH (Fall on Outstretched Hand)

The FOOSH mechanism is one of the most common ways people sustain a distal radius fracture. It occurs when a person instinctively extends their arm to break a fall. Upon impact, the wrist is often hyperextended (bent backward), leading to excessive force on the distal radius. Depending on the angle and force of the fall, it can result in different types of fractures:

• Colles fracture: When the wrist is extended, it impacts the ground, causing the distal radius to tilt dorsally (upward).
• Smith’s fracture: If the wrist is flexed at the time of the fall, the distal radius may tilt volarly (downward).

Who is at Risk?

• Elderly individuals are more prone to FOOSH-related fractures due to weaker bones from osteoporosis.
• Younger individuals involved in physical activities or those who encounter slippery surfaces are also susceptible.

Sports-Related Injuries

High-impact and high-speed sports can lead to distal radius fractures due to the sudden forces involved. Some examples include:

• Skiing and Snowboarding: Falling at high speeds while skiing or snowboarding often leads to wrist fractures, especially when falling forward onto the hand.
• Cycling: In a bike crash, riders often extend their arms to break the fall, increasing the risk of FOOSH-related injuries.
• Contact Sports: Sports like football, rugby, and hockey, where falls or tackles occur frequently, are also common causes.
• Skateboarding/Rollerblading: Falls onto hard surfaces while skateboarding or rollerblading frequently result in distal radius fractures, especially if protective gear (like wrist guards) is not worn.

Who is at Risk?

• Athletes participating in contact sports and those engaging in activities with a high risk of falling (skiing, biking, skating) are at higher risk.

Other Causes:

• Car and Motorcycle Accidents: High-energy trauma from collisions can transmit large forces to the wrist, leading to fractures.
• Direct Blows to the Wrist: An impact on the wrist from an object or another person can also cause a distal radius fracture, such as in fights or accidents.

In all these cases, the type of fracture will depend on the wrist’s position at the time of injury, the force of impact, and the individual’s underlying bone strength.

What symptoms occur with a distal radius fracture?

A distal radius fracture typically causes a range of immediate signs and symptoms due to the bone being broken and the surrounding soft tissues being injured.

Immediate Signs and Symptoms

• Pain:
  • Severe and immediate pain in the wrist or forearm, especially when trying to move the hand or wrist.
  • Pain can radiate up the forearm and make any movement, especially gripping or lifting, very difficult.
• Swelling:
  • Rapid onset of swelling around the wrist, which can extend up the forearm.
  • This swelling may increase over several hours post-injury and is a result of trauma to the bone and surrounding tissues.
• Tenderness:
  • The wrist and forearm area will feel extremely tender to touch, particularly around the break in the bone.
  • Applying pressure to the wrist can provoke sharp pain.
• Bruising:
  • Bruising may develop quickly or over a few hours or days. The skin around the wrist may become discoloured (purple, blue, or red).
• Limited Range of Motion:
  • Due to pain and instability, moving the wrist, hand, or fingers becomes very difficult.
  • In more severe fractures, any attempt to move the wrist could lead to intense pain.

Deformity in Distal Radius Fractures

• Visible Deformity:
  • The wrist may appear deformed, with an abnormal angle or misalignment. In some fractures, the wrist may take on a distinctive “dinner fork” deformity (most common with a Colles fracture), where the hand is displaced upward and back, resembling the shape of an upside-down fork.
  • Smith’s fracture may cause a less prominent deformity but still result in a noticeable bend downward towards the palm.
  • Shortened Appearance: The forearm may look shorter on the injured side due to displacement of the broken bone.
• Abnormal Bony Prominence:
  • You may feel or see a bony protrusion near the wrist if the fracture has caused significant displacement.

Pain and Swelling Patterns

• Pain Patterns:

• Immediate pain occurs directly after the injury and can be sharp or throbbing.
• Worsening pain with movement: Any attempt to use the wrist or hand increases the pain, especially if the fracture is significantly displaced.
• Resting pain: The wrist may continue to hurt even while at rest, especially in the early stages of the injury.
• Swelling Patterns:

• Rapid onset of swelling: The wrist swells soon after the injury as fluid and blood accumulate around the fracture site.
• Swelling extending up the forearm: In more severe cases, the swelling can extend beyond the wrist into the forearm and hand.
• Pressure or tightness: The increasing swelling can create a feeling of tightness in the skin, potentially affecting wrist and finger mobility.

Additional Symptoms

• Numbness or Tingling: If nerves are compressed or damaged, numbness or tingling may occur in the fingers or hands.
• Inability to Grip: Due to pain, swelling, and deformity, gripping objects becomes impossible or very painful.
• Coldness or Discolouration: In rare cases, if circulation is compromised by the fracture or swelling, the hand may feel cold or change colour (pale or blue).

These symptoms are immediate indicators of a possible distal radius fracture, and it’s crucial to seek medical attention as soon as possible. A proper diagnosis through X-rays and examination will confirm the type and severity of the fracture. Access Ortho offers urgent appointments for acute musculoskeletal injuries such as fractures and sprains. 

What are the complications of distal radius fractures?

Distal radius fractures can lead to both acute and long-term complications. The severity of these complications depends on factors like the type of fracture, the degree of displacement, and the quality of treatment. Prompt and appropriate management can reduce the risk of complications, but certain issues may arise even with treatment. It is important to seek specialist orthopaedic care to manage distal radius fractures. Access Ortho specialises in fracture management. 

Acute Complications

• Malunion:

• Definition: When the fractured bones heal in an abnormal alignment, leading to deformity.
• Impact: This can cause functional impairment and abnormal wrist appearance, with potential long-term consequences for wrist mobility.
• Neurovascular Injury:

• Nerve Damage: Fractures may compress or damage nearby nerves, such as the median nerve, which can lead to numbness, tingling (pins and needles), or weakness in the thumb and fingers (similar to carpal tunnel syndrome).
• Blood Vessel Damage: Injury to blood vessels can lead to impaired circulation in the hand or fingers, causing pallor or coldness in the hand.
• Compartment Syndrome:

• Definition: A rare but serious complication where swelling within the forearm muscles leads to increased pressure, cutting off blood supply to tissues.
• Symptoms: Severe pain, numbness, tingling, and weakness. It is a medical emergency that can result in permanent damage if not treated promptly.
• Infection (if surgery is required):
• If the fracture requires surgical intervention (e.g., with plates or screws), there is a risk of infection at the surgical site. Symptoms include fever, increased redness, and pus formation.
• Tendon Injury:
• The tendons that help control wrist and finger movement (e.g., extensor tendons) may be damaged by the fractured bone or during surgery. This can impair hand function or cause pain.
• Joint Stiffness and Reduced Mobility:
• Early after the fracture, swelling and pain can limit wrist movement. Prolonged immobilisation in a cast or splint can contribute to joint stiffness.

Long-Term Complications and Sequelae

• Arthritis:

• Post-Traumatic Arthritis: If the fracture involves the wrist joint (intra-articular fracture), there is a risk of developing arthritis later in life. This condition results from irregular joint surfaces, leading to wear and tear of the cartilage.
• Symptoms: Pain, stiffness, and swelling in the wrist that worsens over time, particularly with activity.
• Chronic Pain and Stiffness:

• Long-term pain and stiffness are common sequelae, especially if the fracture heals improperly or leads to joint damage.
• Patients may experience ongoing discomfort, particularly during wrist movements, and this can limit daily activities.
• Loss of Wrist Function and Mobility:

• Reduced range of motion: Some degree of permanent loss of wrist motion (both flexion and extension) can occur, particularly after complex fractures.
• Weakness: Loss of strength in the wrist and hand; this makes it difficult to grip or perform tasks that require fine motor skills.
• Decreased Dexterity: Some patients may experience reduced hand coordination or difficulty performing tasks that require precision.
• Complex Regional Pain Syndrome (CRPS):

• A rare but severe complication involving chronic pain, swelling, and skin colour or temperature changes in the affected hand.
• Symptoms: Burning pain, sensitivity to touch, changes in skin texture, and joint stiffness.
• CRPS can severely impact hand function and quality of life.
• Malunion or Nonunion:

• Malunion: The bone heals in an abnormal position, leading to deformity and functional limitations.
• Nonunion: In some cases, the bone does not heal properly, this can cause persistent pain and instability in the wrist. Surgery may be required to correct this issue.

Impact on Wrist Function and Mobility

• Reduced Range of Motion:

• Flexion and Extension: Limited ability to bend the wrist forward (flexion) or backward (extension) can hinder activities like typing, lifting, or pushing.
• Pronation and Supination: Difficulty rotating the forearm (turning the palm up or down) can affect everyday tasks like turning door knobs or using tools.
• Decreased Grip Strength:
• Fractures can weaken the muscles and tendons involved in gripping and lifting, making simple tasks like holding objects, shaking hands, or opening jars more difficult.
• Functional Limitations:

• Tasks involving fine motor skills; for example writing, typing, or buttoning a shirt, may become challenging due to stiffness, pain, or weakness.
• High-impact or repetitive activities, such as sports, manual labour, or certain hobbies, may be limited due to long-term discomfort or instability.
• Persistent Deformity:
• Visible deformity from malunion or improperly healed fractures can alter wrist mechanics, leading to abnormal movements, increased strain on tendons, and pain with use.

Prevention of Complications

• Early Diagnosis and Proper Treatment: Prompt medical attention, correct bone alignment (via casting or surgery), and follow-up care are crucial for reducing the risk of complications.
• Physiotherapy: After some distal radius fractures, rehabilitation is required to restore mobility, strength, and function. Once safe, early movement helps prevent joint stiffness and muscle atrophy.
• Monitoring for Arthritis: Long-term monitoring for signs of arthritis in the wrist can help manage and treat pain early.

In summary, while distal radius fractures are common and treatable, they carry the risk of several acute and long-term complications, which can significantly impact wrist function, mobility, and quality of life if not addressed properly. It is, therefore, important to seek medical care from orthopaedic specialists. Access Ortho is an Urgent Care Fracture Clinic that only treats orthopaedic injuries. 

Diagnosis and Tests

How are distal radius fractures diagnosed?

Diagnosing a distal radius fracture involves a thorough medical history, a focused physical examination, and imaging studies (typically X-rays) to confirm the type and severity of the fracture.

Physical Examination Techniques

During the physical examination, the medical practitioner will assess the wrist and forearm for signs of injury. Here are the key techniques:

Inspection:

• Deformity: The examiner will look for visible deformities, such as the classic “dinner fork” appearance seen in Colles fractures, or any abnormal wrist positioning or bony prominence.
• Swelling: Noting any visible swelling, which usually occurs quickly after the injury.
• Bruising and Skin Discolouration: The presence of bruising can suggest internal bleeding or soft tissue damage, while pale or discoloured skin could indicate compromised circulation.

Palpation:

• Point Tenderness: The doctor will gently press along the distal radius and surrounding areas to identify specific points of tenderness or sharp pain, which often correspond to the fracture site.
• Crepitus: Feeling for a grinding or crackling sensation (crepitus) during movement, which may indicate bone fragments rubbing against each other.
• Checking for Bony Prominence: Feeling for displaced bone fragments or bony irregularities, especially along the distal radius and radial styloid process.

Range of Motion Testing (if tolerated):

• Wrist and Finger Movement: The doctor may assess the range of motion in the wrist and fingers, although this may be severely limited due to pain. Restricted movement can indicate fracture severity or associated ligament/tendon injuries.
• Pronation and Supination: Assessing the ability to rotate the forearm (palm up and down) is important to determine joint stability and function.

Neurological Examination:

• Sensory Assessment: This involves checking for signs of nerve injury (especially to the median nerve, which can be compressed in distal radius fractures). It involves testing the thumb, index and middle fingers for numbness, tingling, or altered sensation.
• Motor Testing: The doctor will assess motor function by testing the strength of wrist flexion, extension, and finger movements.

Vascular Examination:

• Capillary Refill: Pressing on the fingernails or skin of the hand to assess how quickly blood returns. A delayed capillary refill could indicate vascular compromise.
• Pulse Check: Feeling for the radial pulse at the wrist to ensure blood flow is intact. A weak or absent pulse may suggest vascular injury.

Importance of Medical History in Diagnosis

A detailed medical history is important in diagnosing a distal radius fracture. The following elements help guide the clinical evaluation and treatment plan:

Mechanism of Injury:

• How the injury occurred: Understanding the mechanism (e.g., fall on an outstretched hand, direct blow, high-impact trauma) provides insight into the potential type and severity of the fracture. A FOOSH (fall on outstretched hand) commonly results in a Colles fracture, while a fall on a flexed wrist is more likely to cause a Smith’s fracture.
• High-Energy Trauma: Injuries from car accidents or sports often involve more complex fractures, like intra-articular or comminuted fractures.

Onset and Duration of Symptoms:

• When the pain started: Whether the pain was immediate or developed gradually.
• Worsening Symptoms: Knowing if pain, swelling, or bruising has worsened over time can help assess the severity.

Patient’s Age and Bone Health:

• Older Adults: In elderly individuals, fractures are often linked to osteoporosis or weakened bones, meaning even low-energy trauma, such as a simple fall, can result in a fracture. A history of previous fractures or osteoporosis can also influence the treatment approach.
• Younger Patients: In younger, more active individuals, a high-energy mechanism (e.g., sports injuries) suggests the need for a more detailed examination for ligament or joint damage.

Previous Injuries or Surgeries:

• History of wrist fractures or previous surgeries on the wrist may influence how the current fracture behaves or heals. Prior injury can also impact the risk of complications, such as post-traumatic arthritis or reduced mobility.

Underlying Conditions:

• Comorbidities like diabetes, rheumatoid arthritis, or other systemic conditions may affect bone healing and increase the risk of complications.
• Medications: Certain medications, such as corticosteroids, may weaken bones over time and predispose the patient to fractures.

Symptoms at the Time of Injury:

• Pain and Deformity: The patient may describe severe pain, noticeable deformity, or popping sounds at the time of injury, which are classic signs of a fracture.
• Functional Loss: Descriptions of immediate loss of function, such as the inability to move the wrist or fingers, indicate the severity of the injury and potential nerve involvement.

Imaging Studies

Although the physical examination and history strongly suggest a distal radius fracture, imaging is required to confirm the diagnosis and determine the type and extent of the fracture:

• X-rays: Standard X-rays (anterior-posterior and lateral views) are the primary imaging tool used to visualise the fracture. They help identify:
  • The location and type of fracture (Colles, Smith’s, Barton’s, etc.).
  • Any displacement of bone fragments.
  • Whether the fracture involves the joint (intra-articular vs. extra-articular).
  • The presence of comminution (multiple bone fragments).
• CT Scan: If the X-ray does not provide enough detail, particularly in complex fractures or those involving the joint surface, a CT scan may be ordered to better assess the alignment of the bones and the fracture’s severity.
• MRI: An MRI is used to provide images of the soft tissue structures around the wrist in cases where soft tissue or ligament damage is suspected or if nerve injuries are concerned.

Access Ortho will assess your injury and arrange the required radiology before confirming the diagnosis and creating a treatment plan. 

Specific Considerations

Certain populations require specific considerations when they have a distal radius fracture. As specialists in orthopaedic care, Access Ortho is aware of the potential concerns and will help manage these. 

Distal Radius Fractures in Children

• Unique Anatomy: Children’s bones are still growing, so they have a thick periosteum (the outer layer of bone) that makes their bones more pliable. This often results in different fracture types, such as:
  • Torus/Buckle Fractures: Incomplete fractures where one side of the bone compresses and “buckles” without breaking completely. Common in children.
  • Greenstick Fractures: The bone bends and cracks on one side but does not break all the way through.
• Healing and Growth: Children’s bones heal faster and have excellent remodelling potential due to ongoing growth. Mildly displaced fractures may correct themselves over time as the bone grows.
• Growth Plate Involvement: Fractures that extend into the growth plate (physeal fractures) require careful monitoring to prevent long-term issues such as growth disturbances or deformities.
• Treatment: Many fractures in children can be treated with casting alone, but more severe fractures, particularly those involving the growth plate, may require surgical intervention.

Osteoporotic Distal Radius Fractures in Older Adults

• Fragility Fractures: In older adults, especially those with osteoporosis, distal radius fractures often occur after a low-energy fall, such as tripping or slipping.
• Bone Quality: Osteoporotic bones are weaker and more prone to comminuted fractures (where the bone breaks into several pieces) due to their decreased density and strength.
• Common Patterns:
  • Colles Fracture is the most common pattern, where the distal fragment tilts dorsally.
  • Displacement may be more significant due to poor bone quality.
• Complications:
  • Delayed Healing: Osteoporotic bones may heal more slowly and are more prone to malunion or nonunion.
  • Post-Traumatic Arthritis: Increased risk of long-term complications, such as joint arthritis, due to poor bone quality and potential joint involvement.
• Treatment: While some fractures can be treated with immobilisation, osteoporotic fractures may require surgical fixation with plates and screws to stabilise the fragile bones. Treatment often includes addressing the underlying osteoporosis with medications like bisphosphonates or calcium and vitamin D supplements.

Athletes and Distal Radius Fractures

• High-Energy Trauma: Athletes often sustain distal radius fractures due to high-impact falls, especially in sports like skiing, snowboarding, skateboarding, cycling, and contact sports (football, rugby, etc.).
• Types of Fractures:
  • Intra-articular Fractures: In athletes, fractures often involve the joint surface due to the force of the injury, increasing the risk of long-term complications like arthritis.
  • Comminuted Fractures: High-energy trauma can cause the bone to shatter into multiple pieces, requiring more complex treatment.
• Complications:
  • Prolonged Recovery: Athletes may face longer recovery times and need aggressive rehabilitation to restore strength and range of motion.
  • Re-injury Risk: Athletes who return to sport too early may face a higher risk of re-injury, especially if the fracture was displaced or required surgical fixation.
• Treatment and Recovery:
  • Early and precise treatment, often involving surgery, is crucial to restore joint stability and prevent future complications.
  • Rehabilitation, including physiotherapy, is essential to regain full wrist function, strength, and mobility.
  • A gradual return to sport is advised, and protective gear (e.g., wrist guards) is recommended in high-risk sports.

These specific considerations highlight the differences in fracture management across age groups and activity levels. This emphasises the need for tailored treatment and rehabilitation to optimise outcomes. Access Ortho is a private fracture clinic that offers rapid appointments for orthopaedic injuries. 

Management and Treatment

Treatment of Distal Radius Fractures

The treatment of distal radius fractures will be determined depending on the severity of the fracture, the patient’s age and activity level, and the degree of displacement or instability. Treatment approaches are generally divided into conservative (non-surgical) and surgical methods, followed by rehabilitation to restore function.

1. Conservative Treatment Options for Distal Radius Fractures

Conservative (non-surgical) treatment is indicated for fractures that are non-displaced or minimally displaced, stable, and expected to heal without the need for surgical intervention.

Closed Reduction and Immobilisation:

• Closed Reduction: If the bones are slightly displaced but the fracture is stable, a doctor can manually realign the broken bone fragments without surgery. This is done using closed reduction under local or general anaesthesia.
• Immobilisation: Once the fracture is realigned (or if it is already in an acceptable position), the wrist is immobilised using:
  • Casting: A  cast is applied to keep the bones stable during healing. Typically, a cast is worn for 4 to 6 weeks, though it can be longer for more severe fractures. Access Ortho offers thermoplastic or fibreglass casts. 

Indications for Conservative Treatment:

• Non-displaced or minimally displaced fractures.
• Stable fractures that are not at risk of shifting or collapsing during healing.
• Low functional demand: This approach is more common in elderly or sedentary individuals with low bone density, where minimal intervention may be sufficient.

Potential Risks:

• Even with proper casting, there is a small risk that the bones could shift during healing, necessitating further intervention (e.g., surgery).

2. Surgical Interventions: Indications and Techniques

Surgical treatment is required for unstable, displaced, or comminuted fractures that cannot be properly aligned or kept stable with casting alone. Surgery ensures proper realignment of the bone fragments and restores wrist function. The medical team at Access Ortho will determine if surgery is required and arrange a referral for this if needed. 

Indications for Surgery:

• Severe displacement: When the fracture fragments are misaligned by more than a few millimetres.
• Comminuted fractures: Multiple bone fragments require stabilisation.
• Intra-articular fractures: Fractures that extend into the wrist joint and need precise realignment to prevent arthritis.
• Open fractures: Where the bone pentrates the skin, requiring immediate surgical repair.
• Failed conservative treatment: When a previously reduced fracture shifts out of place while in a cast.

Surgical Techniques:

• Open Reduction and Internal Fixation (ORIF):

• Description: The most common surgical approach for distal radius fractures. The surgeon makes an incision to access the fractured bone, manually realigns the bone fragments, and stabilises them using metal implants (plates and screws).
• Indications: Used for fractures with significant displacement or instability or those that involve the joint.
• Advantages: Provides strong and stable fixation, allowing for early movement and rehabilitation.
• External Fixation:

• Description: Involves placing pins or wires through the skin and into the bone on either side of the fracture, which are then connected to an external frame in order to hold the bones in place.
• Indications: Often used in cases of severe soft tissue injury or highly comminuted fractures where internal fixation is not feasible initially.
• Disadvantages: Longer recovery time compared to ORIF and higher risk of pin site infection.
• Percutaneous Pinning:

• Description: Pins are inserted through the skin and into the bone to hold the fracture fragments in place without making a large incision. The pins are usually removed after healing.
• Indications: Used for simpler fractures that need stabilisation but don’t require full internal fixation.
• Bone Grafting:
• Description: In complex fractures with bone loss, bone grafts (either from the patient or synthetic materials) may be used to help heal and stabilise the fracture.

3. Rehabilitation and Physiotherapy for Distal Radius Fractures

Rehabilitation and physiotherapy are not always essential after a distal radius fracture. However, a referral may sometimes be required to restore function, strength, and mobility following conservative and surgical treatments. Without proper rehab, some patients may develop stiffness, weakness, or decreased movement in the wrist and hand.

Return to Activity:

• Timing: The return to full activity depends on the severity of the fracture, the type of treatment, and the progress with physiotherapy. It can range from 6 weeks to 6 months.
• Sports and High-Impact Activities: Athletes or individuals with physically demanding jobs may need an extended recovery period, especially if the wrist is severely injured or involved in complex fractures.

Proper treatment and rehabilitation ensure a successful recovery, minimising complications and maximising the return to normal wrist function. If you are concerned about your injury, contact Access Ortho for a rapid appointment. 

Prevention

Preventing distal radius fractures involves adopting strategies to reduce the risk of falls, strengthening the wrist and forearm, and using protective gear in high-risk activities.

1. Fall Prevention Strategies:

• Improve Balance: Engage in exercises like tai chi or yoga to enhance balance and coordination, reducing the risk of falls.
• Home Safety: Remove tripping hazards (e.g., loose rugs, clutter) and ensure well-lit pathways.
• Footwear: Shoes with good grip and support help to prevent slipping, especially on wet or uneven surfaces.

2. Strengthening Exercises for Wrist and Forearm:

• Grip Strength: Use stress balls or grip trainers to improve hand and wrist strength.
• Wrist Flexion and Extension: Regularly practice wrist-bending exercises with light weights or resistance bands.
• Forearm Rotations: Perform pronation and supination exercises (turning the palm up and down) to strengthen forearm muscles.

3. Protective Gear in Sports and High-Risk Activities:

• Wrist Guards: Use wrist guards in sports like skateboarding, snowboarding, and rollerblading to protect the wrist during falls.
• Padding and Support: Wear appropriate gear, such as padded gloves or braces, when participating in contact sports or manual labour that involves repetitive wrist strain.

Outlook / Prognosis

Recovery from a distal radius fracture depends on the injury, the treatment method, and individual factors such as age and bone health. Here’s what you can typically expect during the healing process:

Short-Term Recovery Milestones

First Few Days to Weeks:

• Initial Pain and Swelling: Pain, swelling, and bruising are common immediately after the fracture. Pain is managed with medications, elevation, and ice.
• Immobilisation: Whether treated conservatively with a cast/splint or surgically, the wrist will be immobilised for several weeks. Initial discomfort may persist, but this reduces as healing progresses.

Weeks 4 to 6:

• Cast Removal or Reduced Immobilisation: For many non-displaced fractures, the cast is removed around 4 to 6 weeks after the injury. If surgery was performed, the fracture may be stabilised with internal hardware (plates, screws), allowing for gradual movement sooner.
• Early Rehabilitation: Gentle exercises are usually introduced after immobilisation to regain range of motion. 

Weeks 6 to 12:

• Increased Mobility and Strengthening: As the fracture heals, physiotherapy may help restore the full range of motion and build wrist and forearm strength.
• Pain and Stiffness: Some residual stiffness and discomfort may persist but should gradually improve with regular rehabilitation exercises.

Long-Term Prognosis and Functionality

3 to 6 Months:

• Full Use of the Wrist: By 3 to 6 months, most individuals regain significant wrist function and strength. However, full recovery to pre-injury levels may still take time, especially for those with severe fractures or those who underwent surgery.
• Return to Activities: Patients can typically return to light activities after a few months. However, high-demand sports or manual work may require up to 6 months or longer for full recovery.

12 Months and Beyond:

• Full Healing: Full bone healing and recovery of function can take up to a year, especially for complex fractures involving the joint (intra-articular fractures).
• Long-Term Issues: While many individuals regain full wrist function, some may experience lingering issues, such as:
  • Wrist Stiffness: Despite rehabilitation, some may have long-term stiffness or reduced mobility.
  • Post-Traumatic Arthritis: Fractures involving the joint increase the risk of arthritis later in life.
  • Weakness: Even after healing, wrist strength may be weaker, especially if the injury was severe.

Recovery Time for Distal Radius Fractures

The overall recovery time varies based on the type of fracture, treatment approach, and individual factors.

Non-Surgical Recovery (Conservative Treatment):

• Simple, Non-Displaced Fractures: Recovery typically takes about 6 to 8 weeks for bone healing, followed by additional weeks for regaining full motion and strength.
• Total Recovery Time: 2 to 3 months for most daily activities, but up to 6 months for full strength and function.

Surgical Recovery:

• Displaced or Complex Fractures: Recovery for surgical cases (such as with internal fixation) may take 8 to 12 weeks for bone healing, with physiotherapy continuing for several months.
• Total Recovery Time: 4 to 6 months to return to more demanding activities, but it may take up to a year for complete recovery in severe cases.

Factors Affecting Recovery Time

• Age: Younger individuals typically heal faster than older adults, especially those with osteoporosis or other health conditions.
• Bone Health: Individuals with strong, healthy bones heal more quickly than those with poor bone quality, such as in osteoporotic fractures.
• Fracture Complexity: Simple fractures heal faster than comminuted or intra-articular fractures that involve multiple bone fragments or joint surfaces.
• Treatment Type: Surgical interventions may involve a longer initial recovery time but allow for earlier mobilisation and rehab compared to prolonged immobilisation in conservative treatments.
• Compliance with Rehabilitation: Following a structured physiotherapy program is critical to regaining full function. Delays or poor adherence can slow recovery. Physiotherapy is not always required. 
• Complications: Factors such as infection, malunion (improper bone healing), or stiffness can extend recovery time.

Timeline for Different Types of Distal Radius Fractures

• Non-Displaced Fracture:

• Immobilisation: 4 to 6 weeks.
• Full Recovery: 2 to 3 months for daily activities, up to 6 months for full function.
• Displaced Fracture (Closed Reduction):

• Immobilisation: 6 to 8 weeks.
• Full Recovery: 3 to 4 months for daily activities, 6 to 9 months for full strength and mobility.
• Surgical Cases (ORIF, External Fixation):

• Immobilisation: 4 to 6 weeks (may begin movement earlier with ORIF).
• Full Recovery: 4 to 6 months for most daily activities, with ongoing recovery up to 12 months in severe cases.

Following the treatment plan and seeking specialist care, most patients can expect to regain good wrist function, though more complex fractures may take longer to heal and involve some long-term limitations. Access Ortho specialises in treating orthopaedic injuries such as distal radius fractures. 

When should I go to a fracture clinic?

Distal radius fractures require prompt medical evaluation to ensure proper diagnosis and treatment. The timing of visiting a fracture clinic, such as Access Ortho, depends on the severity of the injury and its symptoms, and it’s essential to recognise when urgent care is needed.

Immediate vs. Delayed Presentation for Distal Radius Fractures

Immediate Presentation:

You should visit a fracture clinic or seek medical attention immediately if you experience any of the following after an injury:

• Severe Pain and Swelling: Intense, unrelenting pain in the wrist, accompanied by significant swelling, suggests a possible fracture.
• Visible Deformity: If your wrist looks bent or crooked, or if there is a noticeable bump or unusual shape in the wrist area, this indicates bone displacement and requires urgent care.
• Inability to Move the Wrist or Hand: If you are unable to move your wrist, fingers, or hand, it could signal a serious fracture or nerve involvement.
• Open Fracture: If the bone has punctured through the skin, this is an emergency. Open fractures increase the risk of infection and require immediate surgical intervention. If you have an open fracture, you need to visit the hospital’s emergency department.
• Numbness or Tingling: Any loss of sensation in the hand, fingers, or wrist, or a feeling of “pins and needles,” may indicate nerve or vascular damage associated with the fracture.
• Inability to Bear Weight through or Use the Arm: If using or bearing weight on the affected arm is painful or impossible, it is essential to get the injury assessed as soon as possible.

Delayed Presentation:

In some cases, patients may delay visiting a fracture clinic if the injury seems mild at first. However, you should still see a doctor within a day or two for:

• Persistent Pain: If your pain persists or gets worse over 24 to 48 hours, even if it initially seemed mild, a fracture might have been missed.
• Swelling Not Improving: Swelling that doesn’t subside after 1-2 days of rest, ice, compression, and elevation (RICE) should be evaluated.
• Stiffness and Limited Movement: If you’re unable to move your wrist after a few days or if the range of motion doesn’t improve, even without severe pain, it’s important to get checked.

Signs That Require Urgent Attention

Some signs indicate that you should seek immediate attention, especially if complications are developing:

• Compartment Syndrome: This is a rare condition which can be very serious, where swelling within the muscles compresses nerves and blood vessels, leading to:
  • Severe, increasing pain, especially when moving the fingers.
  • Numbness or tingling in the hand or fingers.
  • A pale or cold hand due to reduced blood flow.
• Signs of Infection (for Open Fractures):
  • Redness, warmth, or pus around an open wound.
  • Fever or chills.
• Delayed Healing or Re-Injury: If you’ve previously been diagnosed with a distal radius fracture and symptoms worsen (e.g., increased pain, deformity, or swelling), you should return to the fracture clinic for re-evaluation.

Access Ortho is a fracture clinic offering rapid appointments for fractures, sprains and strains. Contact us today if you have concerns regarding an injury. 

What is a fracture clinic?

• Purpose and functions of a fracture clinic

A fracture clinic such as Access Ortho offers specialist care in orthopaedic injuries such as fractures and sprains. A fracture clinic differs from Urgent Care or Emergency Departments as they only treat musculoskeletal injuries and are experts in managing these conditions. In addition, Access Ortho offers follow-up care in the clinic with orthopaedic surgeons. This ensures you receive specialist care until a full recovery is made. 

• What to expect at your distal radius fracture clinic appointment

A fracture clinic appointment is crucial for assessing the extent of your distal radius fracture and developing a tailored treatment plan. Here’s an overview of what typically happens during the visit.

Initial Assessment

Medical History:

• The medical practitioner will begin by taking a thorough medical history. They’ll ask about:
  • How the injury occurred (e.g., fall, sports injury, etc.).
  • Symptoms you’ve been experiencing, such as pain level, swelling, and wrist mobility.
  • Previous medical conditions (e.g., osteoporosis) or any prior fractures or surgeries involving the wrist.

Physical Examination:

• The clinician will carefully assess the wrist, hand, and forearm, looking for:
  • Swelling and bruising.
  • Deformity or signs of bone displacement.
  • Range of motion: You may be asked to try moving your fingers, wrist, and hand to check how much movement you have and to assess pain with movement.
  • Circulation and Nerve Function: The doctor will check for normal blood flow (pulse in the wrist) and nerve function (sensation in the fingers and hand).

Diagnostic Imaging

If not already performed, diagnostic imaging is essential to diagnose and confirm the fracture type and severity.

X-rays:

• X-rays are typically the first imaging study done to provide a clear view of the bones and reveal:
  • The location of the fracture (whether it involves the wrist joint or just the radius).
  • Whether the fracture is displaced, comminuted (in multiple pieces), or stable.
  • If there is any involvement of nearby structures like the wrist joint (intra-articular fractures).

CT Scans or MRI (if necessary):

• A CT scan may be ordered in complex or severe fractures to provide a more detailed image of the bone fragments or joint surfaces.
• An MRI might be needed to assess soft tissue injuries, such as ligament tears, which may accompany the fracture.

Treatment Plan Discussion

The medical practitioner will discuss treatment options. This can include conservative or surgical treatment, depending on the fracture type and severity. If surgery is required Access Ortho will help arrange this. 

Conservative Treatment (Non-Surgical):

• For stable, non-displaced fractures, the following may be recommended:
  • Casting or Splinting: Immobilising the wrist to allow the bone to heal naturally over several weeks.
  • Pain Management: Medications or ice application to control pain and swelling.
  • Follow-up Appointments: You must return to the clinic regularly for X-rays to ensure the bone is healing properly in the cast.

Surgical Treatment:

• For displaced, unstable, or complex fractures, surgery may be necessary. The following are surgical options that will be considered:
  • Open Reduction and Internal Fixation (referred to as ORIF): A surgery to realign the bones and secure them with plates and screws.
  • Other Surgical Options: Such as external fixation or percutaneous pinning, depending on your specific injury.
  • Post-Surgical Care: If surgery is recommended, your doctor will outline recovery time, physical therapy, and follow-up appointments.

Follow-Up Appointments

Before leaving the fracture clinic at Access Ortho, you’ll be scheduled for follow-up visits to monitor your healing. During these visits:

• New X-rays may be taken to assess bone healing.
• Your doctor will adjust the treatment plan based on your progress, which may include:
  • Removing the cast or splint.
  • Referral for physiotherapy.
  • Evaluating for potential complications (e.g., malunion or stiffness).

Commonly Asked Questions

Can you move your wrist with a distal radius fracture?

Typically, movement is severely limited or painful right after the fracture. In some cases, especially if the fracture is not severely displaced, there may be some ability to move the wrist. However, it’s essential to avoid movement until the wrist is immobilised to prevent further damage.

How long does a cast stay on for a distal radius fracture?

A cast is generally worn for 4 to 6 weeks for a non-displaced fracture. More complex fractures may require up to 8 weeks or longer. Your doctor will monitor healing with X-rays and determine when the cast can be removed.

What’s the difference between a distal radius fracture and a wrist sprain?

A distal radius fracture involves a break in the radius bone near the wrist, while a wrist sprain involves stretched or torn ligaments around the wrist. Fractures are typically more painful, cause visible deformity, and require longer recovery with immobilisation, whereas sprains may heal with rest, ice, and supportive wraps.

Can a distal radius fracture heal without surgery?

Yes, many non-displaced or minimally displaced fractures can heal without surgery. These fractures are treated with a cast to immobilise the wrist. Surgery is usually required for more severe, displaced, or unstable fractures.

How painful is a distal radius fracture?

Distal radius fractures are generally quite painful, especially immediately after the injury. Pain can be managed with medications, ice, and immobilisation, but it’s common to feel moderate discomfort for several weeks, especially when moving the wrist.

What activities should I avoid with a distal radius fracture?

Avoid activities that stress the wrist, such as:

• Lifting heavy objects.
• Pushing or pulling movements.
• Sports that involve the wrist (e.g., tennis, basketball).
• Any movement that causes pain in the wrist.
• Contact sports or activities where falling is a risk until fully healed.

It is important to discuss return to activities with your medical team.

When can I return to work after a distal radius fracture?

Returning to work depends on the type of work you do.

• Desk jobs: Many people can return within a week or two, as long as the wrist is immobilised and there’s no risk of re-injury.
• Manual labour or jobs requiring wrist use: It may take 6 to 12 weeks or longer, depending on the severity of the fracture and the demands of the job.

It is important to discuss your return to work plans with your medical team.

How do I care for my cast or splint after a distal radius fracture?

• Keep the cast dry: Use a plastic cover or waterproof material when showering.
• Avoid inserting objects under the cast to scratch an itch—this can cause skin irritation or injury.
• Check for tightness: If the cast feels too tight (e.g., causing numbness or extreme swelling), contact your doctor immediately.
• Elevate your arm: Keep the arm elevated above heart level to reduce swelling, especially during the first few days.

After your cast or thermoplastic splint is fitted at Access Ortho, you will be given instructions on caring for it. 

What are the signs of improper healing in a distal radius fracture?

• Persistent pain or worsening pain after initial improvement.
• Swelling that doesn’t reduce after a few weeks.
• Deformity or unusual shape of the wrist that persists.
• Numbness or tingling in the fingers, which could suggest nerve involvement.
• Delayed return of movement or extreme stiffness in the wrist.
• Unstable feeling in the wrist after cast removal.

If you experience any of these signs, it’s essential to consult your doctor to reassess the healing process.

Can I drive with a distal radius fracture?

You cannot drive with a distal radius fracture as you cannot safely control a vehicle. Whilst in a cast, you should not drive at all. When your cast is removed you should only drive once you have regained strength and full range of motion in your upper limb.

It is important to discuss a return to driving with your medical team.