Conditions

Introduction to Distal Radius Fractures

A distal radius fracture is one of the most common types of bone fractures, particularly in the wrist area. It occurs when the distal (far end) part of the radius bone in the forearm breaks. This type of fracture often happens due to falls, especially when people extend their hands to break a fall, which is why it's sometimes called a "Colles' fracture" (after a doctor who first described it).

General Anatomy of the Wrist and Forearm

The forearm is made up of two main bones:

• Radius: The larger of the two bones on the thumb side of the forearm.
• Ulna: The bone on the little finger side of the forearm.

The radius is important because it helps support the wrist and controls hand movements. The distal radius refers to the part of the radius near the wrist joint, and it connects with the bones of the wrist to allow motion.

The wrist itself is a complex joint that allows the hand to move in various directions. It consists of several smaller bones, ligaments, and tendons, which allow for gripping, rotating, and bending. Due to the wrist's importance in daily tasks, fractures to the distal radius can significantly impact mobility and function.

Causes of Distal Radius Fractures

The most common cause of a distal radius fracture is falling onto an outstretched hand (FOOSH), where the person tries to break their fall with their arm extended. This causes the radius to absorb the force of the fall, leading to a fracture. Other causes include:

• Sports injuries: Activities like skiing, basketball, or cycling.
• Car accidents: Trauma from a sudden impact.
• Osteoporosis: Weakened bones, often due to ageing, can make fractures more likely.
• Direct trauma: A hit or blow to the wrist or forearm.

Symptoms of a Distal Radius Fracture

When someone has a distal radius fracture, they usually experience the following symptoms:

• Pain: Pain at the site of the fracture, especially when trying to move the wrist.
• Swelling: Swelling around the wrist and forearm, sometimes extending to the hand.
• Bruising: Discolouration around the injury site.
• Deformity: In some cases, the wrist may look misshapen or bent in an abnormal position. A ‘dinner fork’ deformity is often seen.
• Limited Movement: Difficulty moving the wrist or hand, especially with gripping or bending.

Dinner fork deformity is seen in a distal radius fracture due to the displaced fracture fragment

Investigations for Distal Radius Fractures

If you think you might have a distal radius fracture, an orthopaedic doctor will perform some tests to confirm the diagnosis. Here are common investigations used:

1. Physical Examination:

   • The doctor will check for tenderness, swelling, and visible deformities.
   • They may gently try to move the wrist to see how much pain is triggered.

2. X-rays:

   • An X-ray is the most common way to diagnose a distal radius fracture. It provides a clear image of the bones and allows the doctor to see if there’s a break, how serious it is, and whether the bone is displaced (out of position).

The front and side view of the wrist shows a fracture of the distal radius with displacement of the fragment. The lateral x-ray also clearly shows the dinner fork deformity as described above.

3. CT Scan or MRI:

   • In some cases, if the X-ray is unclear or if the fracture is complex, a CT scan(which gives detailed cross-sectional images) or an MRI (which shows soft tissues) may be used to get more information about the injury. Knowing the 3-dimensional details about a fracture helps the surgeon plan the surgery as well as prepare the appropriate implants to fix the fracture.

Treatment Options for Distal Radius Fractures

The treatment for a distal radius fracture depends on the type of fracture and the severity of the bone break. Treatment options range from non-surgical to surgical procedures.

1. Non-Surgical Treatment

• Casting: If the fracture is stable and the bones are not out of alignment, a cast or splint is often used to immobilise the wrist and allow it to heal. The cast is usually worn for about 4 to 6 weeks. Patients with unstable or complex fractures may use a cast temporarily while waiting for surgery. In complex fractures, some patients choose to treat their fracture without surgery at all due to old age, frail health or if the fracture is on their non-dominant hand. While we always respect patients’ wishes, we do explain that complex or displaced fractures may cause future problems. These complications include malunion, delayed union, non-union, chronic pain, wrist stiffness and loss of function.

• Ice and Elevation: Ice can help reduce swelling and pain in the early days after the injury. Elevating the arm above the level of the heart can also reduce swelling.

2. Surgical Treatment

• Open Reduction and Internal Fixation (ORIF): If the bones are displaced (misaligned), surgery may be needed to realign the bones. Surgeons use screws, plates, or pins to hold the bones in place while they heal. 

Metal implants are secured with screws to ensure that the fracture fragments heal in an ideal position and allow patients to regain good function of their injured wrist.

• External Fixation: In more complex fractures, an external fixator (a frame attached to the bones from the outside) may be used to stabilise the wrist.

3. Pain Management

• Pain relievers like ibuprofen or acetaminophen are often recommended. In more severe cases, stronger prescription pain medications may be prescribed. These include anti-inflammatory medication such as Arcoxia or Diclofenac.

Rehabilitation and Recovery

After the fracture has been treated, whether through a cast or surgery, rehabilitation is essential to restore full function to the wrist. This process typically includes the following:

1. Physical Therapy:

• Once the bones have healed, your doctor may recommend physical therapy. A physical therapist will guide you through exercises designed to:
  • Restore range of motion: Gradually working on bending and straightening the wrist.
  • Strengthen muscles: Strengthening the muscles in the wrist and forearm to regain full strength and function.
  • Improve coordination: Exercises to help improve the way the wrist works with the rest of the arm.

2. Gradual Return to Activity:

• After the cast is removed or the surgery is done, you will need to ease back into your regular activities. This might involve starting with light tasks and gradually increasing the use of the wrist.
• Wearing a splint or brace for a few weeks may be advised to protect the wrist during the early stages of recovery.

How Long Does Recovery Take?

Recovery from a distal radius fracture varies depending on the severity of the injury and how well the treatment goes. In general:

• Non-surgical recovery: It typically takes 6 to 8 weeks for the bone to heal enough to remove the cast.
• Surgical recovery: Surgery may require a slightly longer recovery time, possibly around 3 to 6 months, to fully regain strength and flexibility in the wrist.

Prevention Tips for Distal Radius Fractures

While you can’t always prevent accidents, there are some things you can do to reduce the risk of a distal radius fracture:

• Exercise regularly: Weight-bearing exercises can help strengthen bones and prevent osteoporosis.
• Wear protective gear: If you participate in sports, use wrist guards or other protective equipment.
• Be mindful of your surroundings: Pay attention to slippery floors, uneven surfaces, and avoid falls by wearing proper shoes.
• Practice fall prevention: Especially for older adults, fall prevention strategies, such as using handrails or reducing clutter, can help prevent wrist fractures.

Conclusion

A distal radius fracture is a common injury, especially from falls. The wrist is crucial for daily movements, so it’s important to treat and rehab this injury properly to regain full function. If you experience a wrist injury, seek medical help early to ensure the best outcome.