Distal Radius Fracture (Broken Wrist)
The wrist is among the most commonly broken bones in the body. In general, the term "wrist fracture" refers to a "distal radius fracture." The wrist is the joint between the two forearm bones (radius and ulna) and the nine carpal bones. The end of the radius (distal radius) is the most common part of the wrist to break. Wrist fractures may occur during trauma, such as a car wreck, or during falls. Wrist fractures happen more easily with age as bone density decreases.
Distal Radius (wrist) Fracture Anatomy
The two bones in the forearm are the radius, which is the larger bone at the wrist, and the ulna, which is the smaller bone at the wrist. The radius is on the same side of the hand as the thumb. The radius and ulna have a joint between them, the distal radioulnar joint, that allows the forearm to rotate. The radius articulates with two of the carpal bones, the scaphoid and the lunate. This part of the joint allows wrist flexion and extension and side-to-side motion. The end of the bone, near the joint surface, is called the metaphysis. This area has weaker bone than in the shaft and is more prone to fracture. Fractures in this area may be referred to as "Colles' fractures," named after the 19th century Irish surgeon who described them in the English literature. Additionally, the end of the ulna, a small projection called the ulnar styloid, is often broken in these injuries.
Distal Radius (wrist) Fracture Symptoms
Most wrist fractures begin to hurt and swell immediately. There is typically tenderness in the area of the distal radius, sometimes accompanied by tenderness around the ulnar styloid. Even when x-rays do not show a fracture, persistent tenderness over the distal radius for several weeks often represents a non-displaced distal radius fracture. Swelling and bruising often extend up the forearm to the elbow and down the hand to the fingers. Patients are often alarmed by bruising across the back of the hand and the back of the fingers, but this is a common finding and does not, by itself, represent an emergency. Some patients develop numbness in the fingers, which is often observed for worsening, but if this progresses rapidly or gets worse over time, it may be an emergency.
Distal Radius (wrist) Fracture Diagnosis
Wrist fractures are typically diagnosed using x-rays of the wrist. Physical exam also contributes to the diagnosis, with continued tenderness directly over the distal radius as the most common finding, along with swelling, bruising, and pain with wrist movement. Advanced imaging, like CT scan or MRI, is rarely required for diagnosis, but these modalities may be used to give better information about the fracture pattern or to look for other injuries.
Distal Radius (wrist) Fracture Treatment
The treatment of distal radius fractures varies based upon fracture alignment, involvement of the joint surface, and patient age and activity level. Some fractures can be treated with only a removable brace, some are treated with a splint or cast, some require reduction (putting the fracture back in place), and some require surgery for pinning, external fixation, or open reduction internal fixation.
Distal Radius (wrist) Fracture Surgery
When surgery is required, it can be done with wires, an external fixator (pins through the skin of the forearm and hand with a bar linking the pins), or plates and screws. Plates and screws are the most common method of fixing wrist fractures. Surgery is typically outpatient (go home after surgery) and can be done either at a surgery center or at a hospital. After surgery, the wrist may be splinted or casted for several weeks, followed by protection in a removable brace. Elevation and the use of ice or ice packs can help with swelling and with pain control. Finger stiffness can be a problem, so the fingers should be exercised beginning the day after surgery to help prevent stiffness. The fracture healing is monitored with x-rays, and full fracture healing typically takes around 3 months, though most patients can begin using the hand for light activities long before the fracture is fully healed.