The forearm consists of two bones, the radius and ulna. The radius is the larger of the two forearm bones. The region towards the wrist is called the distal end. Fractures in this end are most common.
What are the different types of distal radius fractures?
The distal radius can get fractured in various ways, but it generally occurs around 1 inch from the distal end of the wrist. The most commonly occurring distal radius fracture is the Colles fracture, which is characterized by an upward tilting of the broken radius bone. Other types of distal radius fractures include:
- Intra-articular fracture: Fracture extending into the wrist joint.
- Extra-articular fracture: Fracture not extending into the wrist joint.
- Open fracture: Fractured bone that breaks through the skin.
- Comminuted fracture: Bone fractured into more than two pieces.
What are the causes of distal radius fractures?
Falling on an outstretched arm is the most common way to fracture the distal radius. Other causes include:
- Minor falls with the presence of osteoporosis (fragile bones).
- Major trauma to the wrist during a vehicular accident.
What are the symptoms of distal radius fractures?
The symptoms of distal radius fractures include bruising, swelling, immediate pain and tenderness, and limited mobility. The broken wrist may also appear deformed.
How is a distal radius fracture diagnosed?
Your doctor will diagnose distal radius fractures by ordering an X-ray of the wrist to detect broken or displaced bone, and determine the number of pieces the bone is broken into. Sometimes, a computer tomography (CT) scan may be required to get a detailed view of the fractured fragments.
What are the treatment options?
You can protect your wrist with a splint and apply an ice pack while keeping the wrist elevated until the doctor examines it. The choice of treatment will depend on your age, level of activity, nature of fracture and your surgeon’s preference.
If the bone is aligned properly even after the fracture, a plaster cast may be enough to allow it to heal on its own. If the broken bones are nonaligned, realignment of the broken fragments may be required. For this, your doctor may perform closed reduction, which involves moving the broken bone pieces into place and straightening the bone without opening the skin. After the alignment of the bones, your doctor will place a splint or cast on your arm. The splint may be used initially for a few days till the swelling subsides, after which a cast may be placed. The cast may be changed after a few weeks as it loosens with the reduction in swelling.
The healing process will be monitored with regular X-rays. After the cast is removed, the doctor may recommend physical therapy to help improve the function and motion of your injured wrist.
Surgical therapy is recommended for fractures that are completely displaced and cannot be corrected with a cast. Open reduction technique involves directly accessing and aligning the broken bones through an incision. After alignment, the bones can be secured together in the correct position with the use of any of the following or a combination of these techniques:
- Plate and screws.
- Metal pins (titanium or stainless steel).
- External fixation (outside the skin stabilizing frame to hold the bones in its aligned position until it heals).
Surgery is also recommended for all open fractures within a few hours after the wrist injury. The bone and exposed soft tissues are thoroughly cleaned, antibiotics are administered to prevent infection, and internal fixation methods are used to hold the broken bones in correct position. For badly damaged soft tissues, a temporary external fixator may be placed. The internal fixation screws or plates may be placed after several days in a separate procedure.