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📋 Condition Guide2024-01-18

Distal Radius Fracture: Understanding Wrist Fractures

Distal radius fractures are the most common fractures in adults, frequently resulting from a fall on an outstretched hand. Learn about fracture types, diagnosis, treatment options, and what to expect during recovery.

Educational content only. This article is not medical advice. Always consult a qualified orthopedic surgeon or physician for diagnosis and treatment.

What Is a Distal Radius Fracture?

The radius is one of the two forearm bones. Its distal end (the end nearest the wrist) forms the primary joint surface at the wrist and articulates with both the carpal bones (wrist bones) and the ulna. Fractures of the distal radius are the most commonly fractured bone in adults, accounting for approximately 1 in 6 fractures seen in the emergency department.

Common Fracture Patterns

Colles' fracture: The most common type — fracture of the distal radius with dorsal (backward) displacement and angulation of the distal fragment. Typically occurs from a fall on an outstretched hand (FOOSH). Results in the classic "dinner fork deformity."

Smith's fracture: Opposite of Colles' — volar (forward/palm-side) displacement; caused by falling onto a flexed wrist; less common.

Intra-articular fractures: Fracture line extends into the wrist joint surface; particularly important to reduce anatomically as joint incongruity leads to arthritis.

Barton's fracture: Fracture-dislocation involving the wrist joint.

Causes and Risk Factors

  • Fall on outstretched hand (FOOSH): The most common mechanism at all ages
  • Osteoporosis: Significantly lowers the force required to fracture; distal radius fracture is often the first major osteoporotic fracture (a "sentinel" event)
  • High-energy trauma: Younger patients with high-energy injuries

Age-related patterns:

  • Young adults and children: Often require significant force; tend to be stable
  • Older adults (especially postmenopausal women): Low-energy falls; high association with osteoporosis

Symptoms

  • Immediate severe wrist pain after a fall or injury
  • Swelling and bruising around the wrist
  • Visible deformity (dinner fork deformity with Colles' fracture)
  • Tenderness over the distal radius
  • Limited wrist and finger motion

Diagnosis

X-rays (standard): AP (palm-up) and lateral wrist views confirm the fracture and assess alignment:

  • Radial length (ulnar variance)
  • Radial inclination
  • Volar tilt
  • Intra-articular involvement

CT scan: Better characterizes complex intra-articular fractures for surgical planning.

Treatment

Treatment depends on fracture pattern, displacement, patient age and activity level, and bone quality.

Non-Surgical (Closed Reduction and Casting)

For stable or adequately reducible fractures:

  • Manual reduction (realignment) under local anesthesia or sedation in the emergency department
  • Application of a plaster splint or fiberglass cast
  • Repeat X-rays at 1 week to confirm maintained reduction
  • Cast wear: 4–6 weeks

Loss of reduction (fracture slipping back into malposition within the cast) is a common concern, especially in elderly patients with osteoporotic bone.

Surgical Treatment

Indicated for:

  • Significantly displaced, unstable fractures
  • Intra-articular fractures with step-off >2mm
  • Young, active patients requiring anatomic restoration
  • Failure of closed reduction

Surgical options:

  • ORIF (Open Reduction Internal Fixation) with volar plate: The gold standard for most displaced distal radius fractures. A low-profile plate and screws are applied to the palm side of the radius through a small incision. Allows early wrist motion.
  • External fixator: Less commonly used; a frame attached to pins in the radius and hand; appropriate for highly comminuted fractures
  • Percutaneous pinning: Small pins inserted through the skin; simpler than plate fixation; for some fracture patterns

Recovery Timeline

Without surgery:

  • Cast removal: 4–6 weeks
  • Physical therapy: After cast removal for range of motion and strengthening
  • Return to light activities: 6–8 weeks
  • Full recovery: 3–6 months

With surgery:

  • Wound check and suture removal: 10–14 days
  • Wrist motion exercises: Begin within 1–2 weeks
  • Return to light activities: 4–6 weeks
  • Return to heavy work or sport: 3–4 months
  • Full grip strength recovery: 3–6 months (grip strength lags significantly)

Osteoporosis Evaluation

All patients over 50 with a low-energy distal radius fracture should be evaluated for osteoporosis — a DEXA scan to measure bone density is recommended. Treatment of underlying osteoporosis is essential to prevent future fractures (hip fracture is the most consequential future risk).

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