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 syndrome.
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,
this 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 medication.
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 position.
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 basis.
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 operation.
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 post-operative appointment.
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:
- Nerve, tendon or blood vessel damage
- Complex regional pain syndrome
- Ongoing wrist pain and stiffness, or later arthritis, may still occur despite surgery
- Anaesthetic complications.
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.