Distal Radius Fractures

What Is a Distal Radius Fracture?

The wrist is made up of eight small bones and two forearm bones, the radius and ulna. The radius is the bone on the thumb side of your forearm, and the distal radius is the part closest to your wrist. The shape and alignment of these bones allow your wrist to bend, straighten, move side to side, and rotate. A fracture occurs when enough force is applied to the bone, commonly from falling onto an outstretched hand.

The radius is the most commonly broken bone of the wrist. When the wrist is broken, there is usually pain, swelling, and decreased use of the hand and wrist. Often the wrist appears crooked and deformed, though not always. Fractures may be simple, with the bone pieces aligned and stable, or they may be complex, with fragments that have shifted or shattered into multiple pieces. Some fractures break through the smooth joint surface, while others occur near the joint but leave the surface intact. An open fracture occurs when a bone fragment breaks through the skin, carrying some risk of infection.

Symptoms

When you break your wrist, you'll typically experience immediate pain and swelling. The wrist may look deformed or bent at an abnormal angle, though subtle fractures may not show visible deformity. Bruising often develops over the following hours or days. You'll have difficulty using your hand and wrist, and any attempt to move or bear weight on it usually increases the pain.

Numbness or tingling in the fingers can occur if the swelling puts pressure on nerves, or if nerves were injured at the time of the fracture. If you notice these symptoms along with severe pain, deformity, or inability to move your fingers, seek medical attention promptly.

Causes & Risk Factors

Distal radius fractures usually result from falling onto an outstretched hand. The natural reflex is to catch yourself when you're falling, and the force of impact travels through the hand into the wrist. More severe injuries can occur from higher-energy trauma such as car accidents, motorcycle crashes, or falls from significant heights.

Osteoporosis, a condition where bones become more brittle and fragile, makes you more susceptible to wrist fractures. Even a minor fall can cause a fracture in someone with weakened bones. Age, gender (women are at higher risk after menopause), certain medications, and medical conditions can all affect bone density and fracture risk.

Diagnosis

Examination and x-rays are needed to confirm there is a fracture and to determine the best treatment. Your hand surgeon will assess the alignment of the bones, whether the fracture is stable or unstable, and whether the joint surface is involved. Sometimes a CT scan or MRI may be used to get better detail of the fracture fragments and to identify associated injuries.

In addition to the bone, ligaments, tendons, muscles, and nerves may be injured when the wrist is broken. Your surgeon will check for these associated injuries, as they may need to be addressed during treatment. Blood vessel integrity and nerve function are particularly important to assess.

Treatment Options

Treatment depends on several factors including the fracture pattern, whether the bones are displaced or aligned, whether the fracture is stable or unstable, your age, overall health, hand dominance, work and leisure activities, presence of prior injury or arthritis, and any associated injuries.

A splint or cast may be used to treat a fracture that is not displaced, or to protect a fracture that has been realigned. The cast is typically worn for six weeks or longer, depending on how quickly the bone heals. During this time, it's very important to keep your fingers flexible by moving them regularly, provided there are no other injuries requiring finger immobilization.

Other fractures may need surgery to properly realign the bone and stabilize it. Fractures may be held in place with pins, screws, plates, rods, or external fixation. External fixation uses a frame outside the body attached to pins placed in the bone above and below the fracture site. Sometimes arthroscopy is used to evaluate and treat wrist fractures. Your hand surgeon will determine which treatment is most appropriate for your individual case.

Surgery: What to Expect

If surgery is recommended, it's typically performed as an outpatient procedure under local anesthesia, with sedation available for select cases if needed. The surgery involves making incisions to access the fracture, realigning the bone fragments, and securing them with hardware. On occasion, bone may be missing or severely crushed, requiring a bone graft to fill the gap. Bone can be taken from another part of your body, from a bone bank, or synthetic bone graft substitutes may be used.

After surgery, your wrist will be placed in a splint or cast while the bone heals. The hardware used to hold the fracture in place usually stays permanently unless it causes problems later on. You'll be encouraged to move your fingers to prevent stiffness as the wrist heals.

Recovery

Once the wrist has enough stability, motion exercises will be started. Your hand surgeon will determine the appropriate timing for these exercises based on your specific fracture pattern and healing progress. You'll receive a home exercise program to help recover flexibility and strength. While most people manage recovery well with home exercises, hand therapy is often helpful to optimize results and ensure you regain as much function as possible.

Recovery time varies considerably depending on the severity of the injury, associated injuries, your age, overall health, and adherence to your rehabilitation program. It's not unusual for maximal recovery from a wrist fracture to take several months. Some patients may have residual stiffness or aching, particularly with weather changes or after heavy use. If the joint surface was badly injured, arthritis may develop over time. Occasionally, additional treatment or reconstructive surgery may be needed.

When to See a Specialist

If you've injured your wrist and are experiencing pain, swelling, deformity, or difficulty using your hand, seek medical evaluation promptly. Early and appropriate treatment leads to the best outcomes. Even if x-rays have been taken elsewhere, a hand surgeon can provide specialized expertise in managing these complex injuries and guiding you through recovery.

Dr. Lackey specializes in treating wrist fractures and can help determine whether casting, surgery, or other interventions are right for your specific injury. Proper treatment now can prevent long-term complications and help you return to your normal activities as quickly and safely as possible.