Distal Radius Fracture

The forearm is composed of two bones, the radius and the ulna. The radius is the larger of the two bones while the ulna is thinner. They both run the length of the entire forearm, forming the elbow when they meet the humerus, the upper arm bone. The distal radius refers to the end of the radius near the wrist, whereas the word ‘proximal’ refers to the portion of the forearm closest to the elbow.

What is often referred to as the wrist is actually the point at which the ulna and the radius converge on the carpal bones, the small bones that make up the base of the hand. The radius articulates with the carpal bones on the same side as the thumb. The ulna meets the carpal bones on the side of the pinky finger.

Colles Fracture

In a Colles fracture, the broken end of the radius tilts backwards. It is a more common injury.

Smith Fracture

A smith fracture is the opposite of the Colles fracture. In a Smith fracture, the broken bone tilts forward, in the direction of the palm. Smith fractures are often more unstable than Colles fractures and more often require surgery.

Certain distal radius fractures can be treated easily in the emergency department with conservative treatment. Other fracture patterns, however, necessitate an orthopedic surgeon. Open fractures, fractures with associated neurovascular compromise, or unstable fractures will often require surgery. Additionally, fractures that are significantly displaced require surgery. The options for conservative treatment and surgery are below.

Conservative Treatment

First, the doctor will reduce the fracture, meaning they will realign the broken bones to their proper place. They will then immobilize them using splints for up to a week to allow the swelling to reduce. They, or an orthopedic surgeon, will then remove the splint and cast the limb. The cast is changed about 2-3 weeks later and finally removed at around 6 weeks after the injury. The American Academy of Orthopaedic Surgeons recommends weekly X-rays for the first 3 weeks after reduction and immobilization and another radiograph before removal of the cast.

Surgical Treatments

If a patient needs surgery, you will need to see an orthopedic surgeon. The details of the surgery depend on the injury, including the fracture pattern, the associated symptoms, and the degrees of which the bones are displaced. The surgical treatment of the two common FOOSH injuries is detailed below.

Kirshner-wire fixation

Kirshner-wire, otherwise known as K-wire, fixation is better than plaster cast alone at stabilizing an unstable fracture. In this method, K-wire is used in addition to stabilizing the fracture. While it yields better stabilization, K-wire fixation also presents risks for infection and nerve injuries. This is not a common method of treatment anymore.

External fixation

External fixation can serve as a bridging method to definitive treatment or a non-bridging method, meaning it can be the sole intended treatment. When used as the sole treatment, patients were 6x more likely to experience mal-union.  This treatment is typically reserved only for injuries too severe for open surgery.

Open Reduction Internal Fixation (ORIF)

ORIF is the surgical approach. Surgeons use dorsal or volar plates, meaning metal plates based on the internal surface of the back of the hand or the palm of the hand. The volar plates are more popular because they have a lower incidence of tendon complications. ORIF has better outcomes for unstable fractures, but does have risks for infection and tendon injury.

Anyone can suffer from a distal radius fracture. Fractures in the young are often due to sporting injuries or high-speed trauma, while fractures in the elderly can be associated with something as simple as a ground-level fall. Treatment can range from splinting and casting to surgery. The treatment options depend on the severity of the injury. An orthopedic surgeon is the best physician to manage a distal radius fracture. Ask Dr. Morton about your options today.