What is Distal Radius Fracture (Broken Wrist)?
Distal Radius Fracture (Broken Wrist) is something many people experience. There are two bones in our forearm, the ulna, and radius. The ulna is the larger of the two, and at its origin, it is felt on the inside of your elbow. The ulna extends down the forearm to meet up with wrist on the medial (little finger) side. The end of the ulna is the rounded nodule before the wrist.
The radius starts at the elbow and is known for its prominent pointy part of the elbow. The radius extends down to the hand on the thumb side. Although it is the smaller of the two bones, its surface area is larger than the ulna as it meets up with the wrist bones.
The most common fracture of the arm is the distal radius fracture, which means a break in the radius bone near the wrist. There are two types of radius fractures, the Colles and the Smith’s. The Colles fracture is the most common form of a radius fracture. Typically, this occurs with a fall, or trauma to the forearm, while the hand and wrist are extended (bent back).
The Smith’s fracture is less common and is known as the “Reverse Colles” fracture. Again, the injury occurs due to a fall or trauma to the forearm, but with the Smith’s fracture the wrist and hand are flexed (bent inward).
The most common spot for a fracture is about 1” from the end of the bone. There are four types of fractures that can occur:
- Intra-articular fracture, the fracture extends into the wrist
- Extra-articular fracture, the fracture does not extend to the wrist (localized)
- Open fracture, the bone protrudes outside the skin
- Comminuted fracture, the bone breaks into more than two pieces
Understanding if the fracture is nondisplaced or displaced is also important in determining the best course of action. A nondisplaced fracture simply means the bone is still in alignment even though it is broken. A nondisplaced fracture is more complicated because the bone fragments of the fracture do not align as they should. The most complex to treat of the fracture categories are the intra-articular, open, and comminuted fractures.
Not all nondisplaced fractures require surgery. If the doctor can realign the fractured bone, called a reduction, and believes it will be stable, then casting is done. If the fracture affected the smooth part of the joint at the wrist, or if the bone broke into multiple pieces “shattered,” more likely than not surgery is indicated because the fractured bone is unstable.
What causes distal radius fracture?
The number one cause of a distal radius fracture is a fall with the wrist extended. A traumatic event such as a motorcycle or automobile accident is also known to cause a distal radius fracture.
A blunt force to the distal forearm and wrist while playing sports may cause a fracture. Such forces may include a fast-pitched baseball hitting the wrist, a hockey stick slashing the wrist and forearm, or while playing contact sports such as football.
Those who suffer from osteoporosis are at higher risk of a bone fracture because the bones become more fragile and are susceptible to injury. So, even a minor fall can have a traumatic result.
Symptoms of Distal Radius Fracture (Broken Wrist)
If you suspect a fracture, seek immediate medical attention. The most common symptoms of a distal radius fracture are:
- Deformity, but not always (e.g. intra-articular displaced fracture)
- Numbness or tingling in hand and fingers (if nerve involvement)
How is a distal radius fracture diagnosed?
If you have an open fracture, seek immediate medical attention. With an open fracture, you are at risk of infection which should be taken seriously. Also, the more traumatic of a break, like an open fracture, the higher the risk is for other tissue (e.g. muscles, ligaments, tendons, arteries, and nerves) in the area to be damaged.
For some, they are not even sure they have a fracture, which may have some pain, swelling, and bruising, but it is not significant. They may even have a full range of motion of the wrist. These are nonemergency cases which mean if you can’t get in to see your doctor immediately, waiting a few hours or until the next day is okay. Ice the area and if possible immobilize the area until you can get in to see your doctor.
If you have severe pain, significant swelling, a deformity, loss of movement in the wrist or hand, and/or numbness and tingling, this is a situation where you need immediate medical attention. Waiting is not advised.
If a fracture is suspected, an X-Ray will most likely be ordered by your physician. He or she will want a good picture to determine what type of fracture you may have. If there is a significant break, he or she will recommend you to a hand surgeon to further assess the best treatment options.
Treatment of Distal Radius Fracture (Broken Wrist)
The treatment approach will vary depending on the type of fracture. For the extra-articular displaced fractures, for the first few days a splint may be used on the wrist to immobilize it, yet allow for any changes in swelling. Once the swelling goes down after a few days, a custom fit cast is made.
The cast will be changed out in another two or three weeks as the swelling continues to go down. At this point, your doctor may take another X-Ray to make sure the healing process is normal. Another custom cast will be fitted and worn for about another three weeks or so. The average time for a cast is six weeks.
For the more complex fractures like intra-articular nondisplaced, through a physical exam and X-ray results, your doctor will determine if a reduction (realigning the bone) then a cast is appropriate. If he or she determines the fracture is unstable, a surgeon is consulsted for determining the next steps.
With an open fracture or an intra-articular nondisplaced fracture, it is recommended you consult with a hand surgeon. There is a higher risk of infection and malalignment with an open and unstable bone.
The need for surgery is always based on the complexity of the fracture, your age and health, work and hobby activities, as well as if the fracture is on your dominant hand or not. A hand surgeon will take all factors into consideration before determining the best course of action.
If surgery is indicated, the hand surgeon will fix any damaged tissue in the area and will re-align the bone with use pins, screws, plate, external fixators, and/or rods as indicated. The goal is to stabilize the bone for it to heal fully. In rare cases where the bone was crushed or shattered, a bone graft may be needed.
Once the bone is healed, whether you had surgery or not, physical or occupational therapy (PT or OT) is highly recommended. During the healing process the wrist and hand joints become stiff, and due to lack of movement, you will have muscle atrophy in the forearm.
There are PTs and OTs who specialize in the hand and upper arm. These specialized therapists will establish a plan with you based on your specific goals. Your PT or OT will work with you on returning strength to the forearm and hand, regain wrist and hand range of motion, and will focus on returning you to functional activities such as work, hobbies, and sports.
When the bone is healed, and therapy is ready to start, do your homework and search for a health care provider, like a physical or occupational therapist, with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost. As a consumer of health care, you have a choice in finding the right provider for you.
Before you visit with your doctor, please click on Find A Clinic to find a highly qualified PT or OT in your area. This link will help you find a PT or OT that has top national rankings for treating hand injuries.