Distal radius (wrist) fractures
The distal radius is the most commonly fractured (or broken)
bone in the wrist. It usually results from a fall onto an outstretched hand.
The radius crushes into itself and tilts backwards.
This injury is sometimes commonly known as a “wrist fracture”
or as a “Colles fracture”.
What are the symptoms?
Patients usually know right away that something is “not
right” with the wrist. There may be obvious symptoms such as severe pain,
swelling or deformity. Sometimes, there may be associated numbness or tingling
in the fingers.
How is the diagnosis made?
The diagnosis is confirmed usually with an x-ray. However,
an un-displaced fracture may not show up on x-ray and may need special imaging,
such as a CT scan or an MRI scan, to show up. A CT scan may also be required to
better understand a complex fracture pattern.
What are the associated injuries that may occur?
Because an injury like this usually occurs as a result of a
fall onto an outstretched hand, it may be associated with injuries in the elbow
or the shoulder. It is common to have an associated fracture on the little
finger side of the wrist at a small bone called the ulnar styloid; this
fracture usually does not require fixation and usually does not cause long-term
pain even if it doesn’t heal on x-ray. There may be some tearing of ligaments
in the wrist joint; usually, these are not serious, but sometimes they may
cause ongoing issues that require an operation. If there is trauma to the nerve
in the wrist or significant swelling, it is possible to develop carpal tunnel
How is this fracture treated?
There are several aims of treatment. Firstly, it is
important to provide pain relief. This is best done by stopping the fracture
site from moving as soon as possible. Depending upon the type of fracture,
might be done via a removable splint, a temporary half cast or a full cast.
Once the fracture has been immobilised, it may still be
necessary to take medications for the first week or two. This might range from
Panadol to something stronger, such as Panadeine Forte, or an anti-inflammatory
The second aim of treatment is to ensure that the fracture
heals in the correct position. In most cases, treatment in a cast alone will be
sufficient. This may be for six weeks or more. However, sometimes it would be
necessary to perform surgery to straighten and hold the bone in an improved
The third aim of treatment is to restore as much function as
possible once the fracture has healed. This may consist of a physiotherapy
program or some self-directed exercises. This is decided on a case-by-case
If the fracture is not too badly displaced, it can often be
treated in a cast until it has healed. This usually takes about 6 weeks. You
may need regular x-rays during this period to check that the fracture is not
moving out of place.
Once the fracture has healed, you may need a removable brace
to help with pain relief while you are starting to use the wrist again. You may
require physiotherapy to regain motion and strength. This varies from patient
to patient. The wrist is usually not strong enough to return to sports and
heavy work for at least 3 months after injury.
Operations for distal radius fracture
There are several different operations available for a
distal radius fracture. I will talk to you about which is most appropriate
depending upon the type of fracture and its position. We will also take into
account your level of activity and other medical problems.
The simplest form of operation is to push the bone back into
place under an anaesthetic. This is known as a “closed reduction”. This can
then be checked with an x-ray and held in a plaster. Sometimes, this can be
supplemented with smooth pins (called “K-wires”) through the bone which are
left exposed at the skin surface to be pulled out at around 6 weeks after the
For more complex fractures, I may suggest an operation to
place a plate and screws across the fracture. This is a more invasive operation
than using K-wires alone, but holds the fracture more securely.
This is obviously not an exhaustive list of operations. I
will discuss with you the best option for you. In general, the more complicated
procedures give a better hold on the bone and less likelihood that the fracture
will move out of place.
What to expect after the operation
Usually, patients will go home either on the same day or the
day after the operation. There will usually be a half cast on the wrist. You
should keep your hand elevated with the hand higher than the elbow. You will
need to keep your dressings and cast dry until I see you in my office for the
At the post-operative
appointment, I will check the wound and you will usually need to have a further
cast or brace fitted until 6 weeks after the operation. Sometimes, you will be
able to start moving earlier, but I will let you know if this is the case. I
advise you not to drive while you have a cast on.
When the fracture has healed sufficiently, I will usually
refer you to a physiotherapist to start some movement and strengthening
exercises. This normally happens about 6 weeks after the operation. The wrist
is usually not strong enough to return to sports and heavy work for at least 3
months after the operation.
Sometimes, the hardware used to fix the fracture needs to be
removed as soon as the fracture has healed. At other times, the hardware is
designed to stay in the wrist forever. If the plate and screws are in a
position that tendons may be irritated, I may recommend that they be removed a
year or so after surgery.
What are the risks of this injury?
The wrist has taken a
large force to cause this injury. Therefore, it is at risk of ongoing pain and
stiffness, or later wrist arthritis, no matter what the treatment. One of the
aims of treatment is to minimise that risk.
Some of the additional
risks of wrist fracture surgery include:
tendon or blood vessel damage
regional pain syndrome
wrist pain and stiffness, or later arthritis, may still occur despite surgery
Note: This information is current at the date of original
writing and is intended as a general guide only. It may or may not be relevant
to any particular person’s circumstances. You should not rely solely on this
information to guide management of your medical condition, but should discuss
your own situation with your doctor.