Distal Radius Fracture

What is it?

The radius and ulna are the two bones of the forearm. The radius is the bone located on the thumb-side of the wrist, with the ulna being located on the small finger-side. Distal refers to the portion of the bone closest to the wrist while proximal refers to the portion closest to the elbow.

At the level of the wrist, the distal radius contributes to two different joints. The first joint, called the distal radioulnar joint, is between the ulna and the radius and is responsible for rotation of the hand and forearm (supination and pronation). The second, called the radiocarpal joint but commonly referred to as the "wrist joint," is between the small bones of the wrist (carpus) and the radius.

Eighty percent of the force seen by the hand is transmitted through the radiocarpal joint. When someone falls onto an outstretched hand in an effort to brace their fall, the force of the fall can exceed the strength of the bone. This causes the distal radius to fracture. The fracture typically occurs just underneath the radiocarpal joint, but it can extend into the joint creating multiple fragments and an uneven joint surface.

What are the symptoms?

Wrist pain after a fall is the most common patient complaint after a distal radius fracture. Often times, a significant deformity of the wrist is noted due to the displacement of the fracture fragments. In addition, swelling and bruising are common.

How is it evaluated?

The diagnosis is made with x-rays. These will demonstrate the fracture pattern and assist in treatment decisions. Occasionally, in the case of severe fractures or those not clearly seen with x-rays, a CT scan will be necessary.

How is it treated?

Initial treatment of a distal radius fracture is reduction (setting) of the fracture and splinting. This is usually performed in the emergency room. X-rays performed after reduction are then evaluated to determine the need for further treatment.

The goal of treatment is to allow the distal radius fracture to heal in an acceptable position with a smooth, well-aligned joint surface. In some cases, particularly in those where the fracture is only minimally displaced, does not extend into the radiocarpal joint, and is stable after the initial reduction, the injury can be treated with casting alone.

If the fracture is in a bad position, unable to be held in a good position with a cast alone, or has significant involvement of the joint surface, operative treatment is indicated. There are several options available to your surgeon including plates, pins,and external fixation (pins and bars). The decision on which surgical option is most appropriate is best made through discussions between the patient and surgeon after careful consideration of the particular fracture characteristics.