DISTAL RADIUS FRACTURES
The distal radius is the most commonly fractured bone in the upper extremity. The radius is the larger of the two bones in the forearm. The distal segment refers to the part nearest the hand. When this area of the bone breaks, it is known as a distal radius fracture (although sometimes referred to as a wrist fracture or a Colles Fracture).
Most often, the break is due to a simple fall on outstretched hands. Sports and other accidents are also common modes of injury.
Typical symptoms of a broken distal radius may include pain and swelling in the region. There may also be a visible deformity.
The risk of distal radius fractures is related to the strength and density of the bone. Decreased bone density, a condition called osteoporosis, makes a broken wrist much more likely during a fall. This is why distal radius fractures are observed most commonly in the elderly, especially older women who frequently suffer from osteoporosis.
The Injured Wrist
If an injury of the wrist does occur, there are several symptoms that may determine whether a trip to the emergency room is necessary:
- The pain is unbearable.
- A deformity of the wrist exists, especially if the skin is broken.
- Numbness or a loss of blood flow (evidenced by a loss of color) to the hand or fingers.
If these symptoms are present, icing the region and reducing motion should provide some relief until a doctor is able to perform an examination.
To diagnose the injury, a doctor will take X-rays of the wrist. This allows the doctor to visualize the fracture and determine a treatment plan. If a fracture exists, the doctor may note the following characteristics:
- Whether the fracture extends into the joint surface (known as an intra-articular fracture) or remains away (extra-articular).
- Whether the bone has broken the skin. This is called an open fracture and requires special care to prevent infection.
- The amount of pieces the bone has broken into, known as the degree of comminution.
These factors allow the doctor to classify the fracture and apply the most appropriate treatment method.
Once a doctor identifies the nature of the fracture, there exists a wide variety of treatment options. The most appropriate treatment depends on the severity of the fracture, the health and needs of the patient, and the surgeon’s discretion.
The first step of treatment is ensuring the fracture is re-aligned, or anatomically reduced. During this stage, the surgeon will manipulate the bone fragments to return the bone to its natural alignment. Ideally, this is possible through a ‘closed reduction’ or manual manipulation outside of the skin. Often this is all that is required for mild or simple fractures. If a closed reduction is not successful, then an ‘open reduction’ may be used. This involves surgery and is more common in complicated fractures.
If surgery is not required, plaster cast may be applied after reduction to maintain alignment and ensure proper healing of the bone. A cast may need to be reapplied several times over the course of the treatment to allow for a decrease in swelling. Additional X-rays may also be taken to track the progress of the healing. Once the cast is removed, usually around six weeks post-injury, physical therapy may be necessary to reduce residual stiffness and regain the patient’s full range of motion.
If the bone fragments have moved significantly out of place and will not stay in place, a cast may not be sufficient. In this case, the doctor will suggest surgery. There are multiple surgical options, including metal pins, screws, plates, rods and external frames, or any combination of the aforementioned.
Moderate pain is expected to persist for a couple of weeks after initial treatment. Ice and over-the-counter pain medication may provide some relief. If the pain is severe, a stronger pain medication may be prescribed. Care should be taken to keep casts dry or the surgical incision clean until the sutures are removed.
The final outcome of the treatment varies from patient to patient based on fracture severity, treatment method, and the body’s healing response. Due to this variability, patients should discuss individual expectations with their doctor.
Often, with surgical repair of distal radius fractures, removable brace support and initiation of therapy can begin within 3-5 days after surgery. At 6 weeks the patient is usually weaned from the removable brace and strengthening exercises are advanced at the second post-operative visit. By 8 weeks from surgery, most individuals are able to resume general activity without restriction. Return to vigorous activity, including sport participation, is possible by 8-12 weeks from surgery.
While big steps will be made in the first few months with regards to pain and range of motion of the wrist, full recovery may take a little over a year. While unlikely, lingering mild pain or stiffness could last as long as two years.