Distal Radius Fracture (Broken Wrist)
Distal Radius Fracture (Broken Wrist) | Denver, Colorado
A ‘wrist fracture’ is a catch-all term for a fracture of any of the multiple bones that together make up the ‘wrist’.
In my hand surgery practice in the Denver metropolitan area, the most common ‘broken wrist’ I treat is known as a distal radius fracture.
This is an injury in which the forearm bone known as the radius breaks near where it joins the wrist. This location is the ‘distal’ end of the radius bone — thus, the term distal radius fracture.
A broken wrist is most often seen after a slip and fall but can come from other types of injuries as well.
Wrist Fracture Diagnosis & Treatment
A distal radius fracture is typically very straightforward to diagnose. All you need is an x-ray. This will determine whether your distal radius fracture is displaced (the bones have broken and moved out of place) or non-displaced (the bones have broken but haven’t moved at all). Oftentimes this distinction between displaced or non-displaced will determine whether you would benefit from surgery.
Contrary to popular belief, there is no difference between the terms crack, fracture, or break!
In rare cases, a CT scan may be necessary after x-ray diagnosis of a distal radius fracture to assist in surgical planning. This typically only occurs in the most severe of distal radius fractures.
Wrist Fracture Treatment
Distal radius fracture after open reduction internal fixation (ORIF) with a volar-locked plate. Most distal radius fractures are now fixed with this surgical technique.
As alluded to above, some distal radius fractures benefit from surgery while others can be successfully treated without surgery in a cast, splint, or brace. The primary factor that drives this decision is the displacement of the fracture fragments, though several additional variables are also important.
If you do need surgery, there are various techniques to fit the needs of the fracture. However, the vast majority of distal radius fractures will be fixed with plates and screws via a procedure known to surgeons as ‘open reduction, internal fixation’ (ORIF). Translated, this literally means, make an incision, put the bones back into alignment, and fix the bones in place with plates and screws (see Figure to the right).
Additional Information
While this is an overview of distal radius fractures, if you’d like more information on this topic, please continue reading through my patients’ frequently asked questions below, or see my ‘deep dive’ section to the right of the FAQs where I have links to the longer-form articles I have written about various topics related to wrist fractures and their treatment.
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The Basics
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A distal radius fracture is the most common type of broken ‘wrist.’
This is an injury in which the forearm bone known as the radius breaks near where it joins the wrist. This location is the ‘distal’ end of the radius bone — thus, the term distal radius fracture.
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A distal radius fracture is typically caused by an impaction force directed across the hand or wrist.
This is most commonly seen after falling onto an outstretched hand. Other hand and wrist impacts such as athletic injuries or motor vehicle accidents can also cause a distal radius fracture
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You may be at a higher risk of experiencing a distal radius fracture if you are aging or if you have been diagnosed with osteoporosis, a condition that involves thinning of your bones.
You may also be at risk if you participate in ‘high energy’ activities, such as downhill skiing, mountain biking, or motorsports.
Wrist Fracture Symptoms & Diagnosis
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Concern for a wrist fracture arises after sustaining a sizeable impaction force to the hand or wrist.
If you have suffered such an injury and have pain that doesn’t respond to basic measures (over the counter medications, bracing, icing), progressive bruising, deformity at the wrist, or numbness/tingling in the fingers, please get yourself to an emergency room right away for diagnosis and treatment.
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Diagnosis of a distal radius fracture is straightforward. All you need is an x-ray.
Unfortunately, there are no tricks or at-home methods to diagnose a fracture without an x-ray.
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Rarely, a CT scan may be ordered after x-ray diagnosis of a distal radius fracture. This is typically to assist the surgeon with planning prior to surgical fixation, rather than aiding in the diagnosis itself. CT should only be used in the most severe of distal radius fractures.
MRI imaging does not play a role in the diagnosis of a distal radius fracture
Wrist Fracture (Distal Radius) Treatment
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If you have sustained an injury to your wrist and you think it may be broken, there are several at-home treatments to start right away while waiting to get in to see a doctor. Let’s walk through how to treat your wrist (or any injury) with what is commonly known as R.I.C.E. therapy.
R - Rest. If your wrist hurts following an injury, try to stop using it as much as possible. Even better, obtain a standard velcro wrist brace from your local pharmacy or a friend. This will immobilize the joints of your wrist and allow your injury to rest. While this may not be enough to definitively treat your injury, this will help with the initial stages of pain and inflammation.
I - Ice. It can be very helpful to use ice on the injured wrist. Be sure you have a protective layer between the ice and your skin (eg, dish towel, clothing). Do not ice the area for more than 20 minutes at a time. I typically recommend icing in a “20 minutes on, 20 minutes off” pattern.
C - Compression. Of all the stages of R.I.C.E., be the most careful with compression. Some find that some gentle compression feels good after an injury for extra stabilization. In general, we would recommend accomplishing this by using an elastic wrap bandage (Brand example: ACE wrap). However, it is crucial that you don’t stretch the elastic wrap bandage while you wrap. This will provide too much compression, and if your wrist swells, you can develop a painful or even permanently damaging condition. If you are interested in using compression, be sure to gently apply the bandage and re-evaluate frequently to ensure it is not becoming too tight with your wrist swelling. Never apply compression before going to sleep for the night.
E - Elevation. This is the most important one. I wish this were first in the mnemonic, but then it would spell E-R-I-C. Anyways, elevate, elevate, elevate. The higher the better. When you can, keep the wrist above the level of the heart. When that’s not possible, keep your hand above your elbow. Gravity is your friend! The more you elevate your injured wrist, the less swelling you will experience. The less swelling you experience, the less pain you will have. This is particularly crucial in the first few days after an injury.
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Some fractures need surgery to result in optimal function, and this type of surgery typically would be easiest to complete within approximately 7-10 days from the date of your injury. Additionally, wrist injuries can be associated with ligament, nerve, and blood vessel injuries that should be treated without delay to prevent long-term injury, pain, or dysfunction.
If you notice that your wrist is crooked, your broken bone comes through the skin, or you notice any numbness/tingling in your fingers after an injury, please get yourself to an emergency room immediately.
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Some wrist fractures do not need surgery. In this situation, your fracture fragments most likely did not move significantly out of place. This can be treated with a combination of splints and casts.
I typically use a splint for the first week or two while your swelling is more significant. When the swelling subsides, I transition you to a cast.
The biological process of bone healing typically takes 6-10 weeks to finish. During this period, I follow all fractures with periodic X-rays.
At some point between 4 and 8 weeks, the cast will be removed and you will transition to a removable brace. You will also begin range of motion exercises at this time.
Some patients benefit from formal mobilization and strengthening with our Certified Hand Therapists and others are able to rehab on their own with a simple home exercise program.
As always, I tailor your treatment to what you need.
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A reduction is the medical term for ‘re-setting’ or moving the displaced broken bones back into alignment.
In the case of a distal radius fracture, this is accomplished by injecting numbing medicine into the fracture in your wrist. Occasionally sedation is needed.
Once your fracture is numb, the medical provider will use their hands to pull or ‘set’ the bones back into alignment. They will then immediately place your arm into a splint. A splint is similar to a cast, but it is not circumferentially enclosed like a cast. This allows room for the swelling expected after this injury. The splint will harden in place and maintain the improved alignment of your wrist.
Wrist Fracture (Distal Radius) Surgery
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The decision regarding whether you need surgery for your distal radius fracture is often a complex one. This will almost always require input from a specialist, such as an orthopedic hand and upper extremity surgeon. But in general terms, there are three large categories of fractures that benefit from surgery.
The first is ‘open’ or ‘compound’ fractures. If your bone has come through the skin, it will need surgery to adequately clean the fracture before fixing it so as to best prevent infection.
The second category is ‘unstable’ fractures. In short, this means fracture fragments that have moved out of place and are unlikely to stay aligned during the healing process. This fracture requires surgery to hold the bone in proper alignment (usually with a metal plate and screws) while your body heals across the fracture.
The last major category is intra-articular fractures (those that involve the wrist joint). The joint is the space where the smooth end of the radius bone rubs against the other bones in your wrist when you bend your wrist up and down. If the fracture enters and disrupts this smooth surface, most will benefit from surgery to restore the anatomy. Otherwise, a deformed joint surface can lead to early and painful arthritis.
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There is a wide range of surgeries one could need to fix a distal radius fracture. Ultimately, that decision will come down to the exact fracture pattern and your surgeon’s expertise in evaluating how best to stabilize the bone. However, the vast majority of these fractures will be treated with a plate and screws, placed on the ‘palm’ side of your radius bone. This is referred to as an ORIF (open reduction internal fixation) with a volar-locked plate.
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As I’ve said before, ‘recovery’ is a very subjective term. In broad strokes, the bone will take 6-8 weeks to heal. Below is the typical outline (I use this in ~ 85% of patients, this won’t apply in more complex fractures) of healing following surgery to fix a distal radius fracture:
Surgery - 2 weeks: Wear a post-operative splint full-time. You will work on the motion of making a fist with your fingers
Begin 2 weeks: Removable splint made by hand therapy, begin to work on gentle wrist range of motion exercises. These will progress over several weeks. No lifting greater than 2 pounds with the hand/wrist.
Begin 6 weeks: If the fracture is sufficiently healed and you have regained the appropriate wrist range of motion by six weeks, I typically let my patients resume some light lifting activities that progress thereafter. Wean out of the brace for light activities.
Begin 8 weeks: Your hand therapist will begin to add strengthening exercises to your rehabilitation program.
3-4 months: Return to heavy activities and/or impact sports. Most patients feel 90% of their former selves by this point. Occasional aches and pains, or a bad day here or there are still expected.
9 months - 1 year: “Full” recovery, where you may have to stop and think about which wrist you had injured.
For even more information on the typical recovery following distal radius surgery, see my start-to-finish guide specific to this surgery. CLICK HERE to read more.
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Yes, the plate and screws are carefully designed to be permanent. In approximately 5% of cases, the hardware can become irritating to the surrounding tendons over time.
If this occurs, the plate and screws should be removed so the tendons do not rupture.
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The hardware I typically use is made of a titanium alloy and thus will not set off airport or other metal detectors.
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If you have seriously injured your hand or upper extremity, please do not delay in seeking care from a trained hand and upper extremity surgeon. If you happen to be in Colorado, it would be my privilege to care for you (schedule here).
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All surgeries have risks, many of which are generic to surgery itself. I go over these in detail with you before surgery as part of the informed consent process. Examples include bleeding, infection, damage to surrounding nerves/vessels, anesthesia risks, or failure of the procedure.
There are a couple of risks specific to distal radius fracture fixation that are worth highlighting.
The first is arthritis. Any time a fracture enters a joint, it disrupts the previously pristine smooth joint surface. Even if the joint is put back together perfectly, you will have a lifetime increased risk of developing arthritis in the joint. Many distal radius fractures disrupt the joint in some form or another.
This risk goes down significantly but is not fully eliminated, with a well-performed distal radius fracture fixation surgery.
The next is hardware irritation. While the plates and screws are designed to be able to stay forever, they occasionally rub on the surrounding tendons. If this goes on for too long, the tendons can rupture. And that’s a big deal to try to fix. So if you develop any signs of tendon irritation after your wrist fracture is healed, you may need a second surgery for plate removal.
The last big risk with any fracture surgery is nonunion. Nonunion occurs when the fracture ends just never heal back together. All I do in surgery is put the bones back in alignment and fix them there with hardware. Your body still has to biologically heal.
Risk factors for nonunion include tobacco use, vitamin D deficiency, diabetes, and other chronic health conditions. If you develop a nonunion, often a second, more involved surgery is required.
This is by no means an exhaustive list of surgical risks, but rather highlights the more common things to be aware of prior to a distal radius fracture surgery.
