Distal Radius Fracture

Background

A wrist fracture usually results from a traumatic injury and commonly involves a fractured distal radius which is the technical term for a break of the radial forearm bone near the wrist. There are many elements that are important to consider when treating these, including the patient’s age, activity level, medical history and specifics as they relate to the fracture itself.

Causes

These fractures result from trauma, such as a fall. Higher energy mechanisms are also possible, such as motor vehicle accidents or falls from significant height. In all cases, the deforming forces are focused at the wrist and this leads to a break of the distal radius and often also the tip of the ulna which is called the ulnar styloid.

Symptoms

Distal radius fractures cause pain, tenderness, bruising and swelling at the wrist. If the fracture is displaced, there may be a visible deformity of the wrist. Numbness can occur if there is pressure on the median nerve, which is called acute carpal tunnel syndrome.

Diagnosis & Treatment

The injured forearm is assessed from the elbow to the wrist. Range of motion is typically diminished, in conjunction with bruising and swelling. Xrays are critical to make the diagnosis and guide treatment. Occasionally a CT scan is ordered. Minimally displaced fractures can be braced or casted. Displaced fractures may require surgery which entails realigning the fractured bone, and placing a plate and screws to stabilize the fracture while it heals. Open fractures (with a break in the skin) almost always require surgical intervention.

The following case studies showcase various methods of fracture repair.

This is an active dentist who fell while working out and fractured both distal radius and ulna. We treated both fractures with ORIF (Open Reduction and Internal Fixation). She was able to get her wrist moving early. She is 5 years out, and with near full range of motion.

This is the approach to a very routine wrist fracture with ORIF. The patient can come out of the splint at 1 week after surgery and start moving the wrist, shower and get the incision wet etc. The plate and screws day in unless the patient prefers to have them removed.

This patient had a very distal fracture and I used a technique called Dennison pinning to capture the volar ulnar corner with K-wires in combination with a standard volar plate. If one looks carefully there was actually an additional longitudinal split of the radial shaft which I repaired with lag screws.

This patient with osteopenia presented with a comminuted fracture. I treated this with a combination technique. He also had a split along the shaft for which I placed lag screws in minimally invasive fashion, in addition to a so-called dorsal spanning plate which is usually removed after 3 months. Images before and after the initial surgery are shown here:

Once all the hardware was removed, 3 months later, the joint surface was well aligned.

Additional views.