Distal Radius Fracture

What are Distal Radius Fractures

A distal radius fracture, often referred to as a broken wrist, occurs when there is a break in the radius bone near the wrist.

The radius is one of the two long bones in the forearm, with the distal radius being its end closest to the wrist. Distal radius fractures are the most common type of wrist fractures.

Types of Distal Radius Fractures

There are various forms of distal radius fractures, each distinguished by the injury’s nature and the bone’s positioning after the fracture.

Colles’ Fracture

This occurs due to a direct impact on the palm, often resulting from using the hands to break a fall. It leads to a complete fracture of the radius. There may be a visible deformity around the wrist, but the wrist joint remains intact.

Smith’s Fracture

This type of fracture happens when falling backwards and bending the wrist upon impact, causing the end of the radius to be displaced.

Barton’s Fracture

This occurs from a fall on the top of a bent wrist, leading to a compression injury that extends into the wrist joint. This often requires imaging tests, like an MRI scan, to accurately diagnose.

Symptoms

Individuals with a distal radius fracture typically exhibit several indicative symptoms, which may vary in intensity based on the fracture’s severity.

• Pain: The most immediate and noticeable symptom is pain in the wrist, particularly on the thumb side. The intensity of the pain can range from moderate to severe, depending on the fracture’s nature.
• Swelling and Bruising: Swelling and bruising around the wrist are common, indicating underlying tissue damage.
• Deformity: In cases of severe fractures, the wrist may appear deformed or bent. This visual cue is a strong indicator that the fracture requires immediate medical attention.
• Numbness: In very severe cases, where the fracture affects the nerves, numbness in the fingers can occur. This may suggest potential nerve damage, necessitating urgent medical care.

Causes and Risk Factors

A distal radius fracture can result from various causes and is influenced by several risk factors:

• Falls
  The predominant cause of distal radius fractures is a fall onto an outstretched arm. This mechanism is common in various scenarios, ranging from every day slips to sports-related falls.
• Trauma
  High-energy impacts, such as those experienced in vehicular accidents or during contact sports, can result in this type of fracture. This may occur even in individuals with healthy bones.
• Osteoporosis
  Osteoporosis is a risk factor, particularly in older adults. This condition weakens the bones, making them more susceptible to fractures. In severe cases, even a minor fall or low-impact trauma can cause a fracture.
• Age-Related Degeneration
  Older individuals are more likely to experience distal radius fractures, partly due to decreased bone density.

Non-Surgical Treatment Options

Non-surgical treatment for distal radius fractures is considered when the fracture is stable and the bone alignment remains reasonably intact.

Casting

If the broken bone is well-aligned, a cast is applied to immobilise the wrist and facilitate natural healing. The type of cast and the duration of its use depend on the fracture’s severity and the patient’s healing progress.

Closed Reduction

For fractures where the bone is misaligned, a procedure called closed reduction is performed. This involves manually realigning the bone fragments without surgical intervention. After realignment, a cast or splint is applied to maintain the correct positioning.

Splinting

Initially, a splint may be used to accommodate swelling and provide support. As swelling reduces, a more rigid cast is usually applied.

Surgical Treatment Options

In certain cases, a distal radius fracture may require surgical intervention, especially when the fracture is unstable, severely misaligned, or involves joint surfaces.

• Open Reduction and Internal Fixation (ORIF)
  This method is often necessary for complex fractures. It involves making an incision to directly access the fracture site. The bones are realigned (open reduction) and then fixed in place using internal fixation devices such as plates and screws. Metal pins, which can be stainless steel or titanium, can also be used to stabilise the fracture. This is commonly employed in children with growing bones.
• External Fixation
  For certain types of fractures, especially those with severe soft tissue injury, an external fixator may be used. This involves placing a stabilising frame outside the body to hold the bones in the correct position for healing.

Prevention Strategies

Preventative measures for distal radius fractures focus primarily on reducing the risk factors associated with these injuries.

• Implementing Strategies to Prevent Falls: Fall prevention strategies can be implemented, as falls are a major cause of distal radius fractures. This may involve environmental modifications, balance training, and physical therapy.
• Maintaining Bone Health Through Diet and Exercise: Individuals, especially those aged 50 and older, should try to maintain bone health. This can be achieved through a balanced diet rich in calcium and vitamin D, and regular exercise.
• Managing Underlying Conditions: Underlying conditions like osteoporosis should be managed and treated effectively to help reduce the risk of distal radius fractures.
• Engaging in Regular Screenings: Regular screenings, particularly in individuals who have had previous fractures, can help in identifying those at higher risk and in implementing appropriate preventative measures.