What are distal radius fractures?
The radius is the major bone in the forearm that makes up part of the wrist. A fracture or break in the distal radius generally occurs secondary to trauma, commonly from a fall from a standing height, but in some cases with higher energy. These fractures can be simple two-part fractures, but in some instances, the bone can fracture in multiple places. These breaks can lead to significant deformity and loss of function.
What are the symptoms of distal radius fractures?
Patients develop immediate pain and swelling and there can be a visible deformity or prominence of the fracture end under the skin. There can be associated damage to the nerves. The patient will have limited use of the wrist in the acute phase and continued pain and potentially poor function until the fracture heals.
How is it diagnosed?
It is diagnosed by taking a careful history and performing a detailed examination. There are potentially other associated injuries of bones in the hand or the forearm, which the clinician will carefully exclude. Assessment will be made to ensure that the associated nerves and vessels have not been injured. X-ray, and CT imaging in selected cases, can be useful to exclude other potential injuries and to further assess the fracture particularly in cases where surgical management is required.
How is it treated?
Treatment begins with symptomatic management using pain killers, a sling, and a brace or plaster cast for support and to immobilise the fracture.
The displacement of the fracture, the location and the degree of trauma associated help to guide the decision regarding the need for surgery. The demands of the patient both for their occupation and for sporting activities are a key component of making this decision.
The location of the fracture will guide treatment and options for non-operative management include removable splints, and plaster treatment following a controlled reduction of the fracture either under local or general anaesthetic.
Surgical treatment can be with either percutaneous pins or open reduction and internal fixation with metal plates and screws. This allows for the best chance of achieving a stable fixation which facilitates early full range of movement.
Surgery can provide the patient with a more predictable and earlier return to work and sporting activities. It can also lead to decreased pain, improved range of movement and function when indicated. Postoperative physiotherapy is an essential component to optimise outcomes from surgical treatment.