What Is a Distal Radius Fracture?
When someone falls on their outstretched hand, they sometimes get a “broken wrist.” The bone that is usually broken is called the radius. The end of the bone nearest the wrist is called the distal end. The medical term for “broken bone” is fracture. Therefore, the medical term for the most common type of “broken wrist” is a distal radius fracture (the larger forearm bone is broken near the wrist).
This kind of fracture is very common, and the radius is the most commonly broken bone in the arm. The break usually happens when you fall and land on your outstretched hands. It can also happen in a car accident, a bike accident, a skiing accident, and similar situations. Sometimes, the other forearm bone (the ulna) is also broken. When this happens, it is called a distal ulna fracture.
This fracture was first described by an Irish surgeon and anatomist, Abraham Colles, in 1814; hence the name “Colles’” fracture.
A broken wrist usually causes pain and swelling and frequently causes a deformity, causing the wrist to look bent. See your doctor for a diagnosis. The doctor will take an X-ray of the wrist. The fracture is almost always about 1 inch from the end of the bone. If the fracture extends into the joint, it is called an intra-articular fracture; if it does not, it is called an extra-articular fracture. (“Articular” means “joint.”) If the fractured bone breaks the skin, it is called an open fracture. If the bone is broken into more than two pieces, it is called a comminuted fracture. A fracture is more difficult to treat if it is intra-articular, open, or comminuted.
Many distal radius fractures in people over 60 are due to osteoporosis (decreased density of the bones) if the fall was relatively minor (a fall from a standing position). They can happen even in healthy bones if the trauma is severe enough (for example, a car accident or a fall off a bike). The best prevention is maintaining good bone health and avoiding osteoporosis and falls. Older patients with problems keeping their balance need special attention to prevent falls. Wrist guards worn on the forearms may help to prevent some fractures, but they will not prevent them all.
Symptoms
When you have a distal radius fracture, you will almost always have a history of a fall or some other kind of trauma. You will usually have pain and swelling in the forearm or wrist. You may have a deformity in the shape of the wrist if the fracture is bad enough. The presence of bruising (black and blue discoloration) is common. See your doctor if you have enough pain in your arm to stop you from using it normally. You may want to go directly to an orthopedist (bone doctor), who can usually take an X-ray right in the office and tell you what is happening. If your doctor’s office is closed, the injury is not very painful, and the wrist is not deformed, you can usually wait until the next day. If the injury is very painful, the wrist is deformed, you have numbness, or your fingers are not pink, go to the emergency room. You may want to protect the wrist with a splint, apply ice to the wrist, and elevate it until you get to the doctor’s office.
Treatment
There are many treatment choices. Your orthopedic surgeon will describe what options are right for you. The choice depends on many factors, such as the nature of your fracture, your age and activity level, and your surgeon’s personal preferences.
One choice is to leave the bone the way it is if it is in a pretty good position. Your doctor may apply a plaster cast until the bone heals. Or if the position (alignment) of your bone is not good and likely to limit the future use of your arm, your orthopedic surgeon may suggest correcting the deformity (the medical term for correcting the deformed bone is reduction). A closed reduction is if the bone is straightened out (reduced) without cutting into the skin (incision). After the bone is properly aligned, a splint or cast may be placed on your arm. A splint is usually used for the first few days to allow for a small amount of normal swelling. A cast is usually added a few days to a week or so later, after the swelling goes down, and changed two or three weeks later as the swelling goes down more and the cast gets loose. X-rays are taken, depending on the nature of the fracture, either at weekly intervals for three weeks and then at six weeks (if the fracture was reduced or felt to be unstable) or less often if the fracture was not reduced and thought to be stable. The cast is removed about six weeks after the fracture happened. At that point, physical therapy is often started to help improve the motion and function of the injured wrist.
If your orthopedic surgeon feels that the position of the bone is not acceptable for the future function of your arm and that it cannot be corrected or kept corrected in a cast, he or she may recommend an operation. There are many ways of performing surgery, including reducing the fracture in the operating room without making an incision (closed reduction) or by making an incision (open reduction) to improve the alignment of the bone. In the operating room, your orthopedic surgeon may choose to hold the bone in the correct position with only a cast or by inserting metal (usually stainless steel or titanium) pins, a plate, screws, an external fixator, or any combination of these techniques.
Recovery
This is a very simple question. Unfortunately, there is no simple answer. The kinds of distal radius fractures are so varied, and the treatment options are so broad that it is hard to describe what to expect. Most fractures hurt moderately for a few days to a couple of weeks. Many patients find that using ice, elevation (holding their arm up above their heart), and simple, non-prescription medications for pain relief are all that are needed. One combination is ibuprofen (sold as a generic or under the brand names Motrin® or Advil®) plus acetaminophen (sold under the brand name Tylenol®, and also as a generic, often marked on the box “non-aspirin pain reliever”). Combining both ibuprofen plus acetaminophen is much more effective than either alone (the medical term for this is synergistic). If pain is severe, patients may need to take a prescription strength medication, often a narcotic, for a few days. Discuss these options with your doctor.
Casts and splints must be kept dry, so use a plastic bag over your arm while showering. If you do get it wet, it will not dry easily (you can try using a hair dryer on a cool setting). There are no actual “waterproof” casts, but some options are available that have their pluses and minuses. Discuss this with your doctor.
Most surgical incisions must be kept clean and dry for five days or until the sutures (stitches) are removed, whichever occurs later.
Everyone wants to know, “Can I return to all my former activities, and when?” This is a great question that seems relatively simple and straightforward, but the answer is complex. Most patients return to all their former activities, but what will happen in your case depends on the nature of your injury, the kind of treatment you and your surgeon decide upon, and how your body responds. You will need to discuss your case with your doctor for the specifics of your case, but some generalizations can be made.
Most patients can expect the following:
The cast will be removed at about six weeks.
Physical therapy will begin if your doctor feels it is needed within a few days to weeks after surgery or right after the last cast is removed.
Light activities such as swimming or working out the lower body in the gym can resume within a month or two after the cast is taken off, or after surgery.
More vigorous physical activities, such as skiing or football can resume between three and six months after the injury.
Almost all patients will have some stiffness in the wrist, which will generally diminish in a month or two after the cast is taken off or after surgery and will continue to improve for at least two years. You should expect your recovery to take at least a year. You will still feel some pain with vigorous activities for about that long. Some residual stiffness or ache is to be expected for two years or possibly permanently, especially for high-energy injuries (such as motorcycle crashes, etc.) in patients over 50 or in patients who have some osteoarthritis. However, the good news is that the stiffness is usually minor and may not affect the overall function of the arm. Remember, these are general guidelines and may not apply to you and your fracture. Ask your doctor for specifics in your case. Your doctor knows that returning to activities is important to you. Finally, osteoporosis is a factor in as many as 250,000 wrist fractures. It has been suggested that people who suffer a wrist fracture may need to be screened for osteoporosis, especially if they have other risk factors. Ask your doctor if you need to be screened or treated for osteoporosis.