A distal radius fracture almost
always occurs about 1 inch from the end of the bone. The break can occur in
many different ways, however.
One of the most common distal radius
fractures is a Colles fracture, in which the broken fragment of the radius
tilts upward. This fracture was first described in 1814 by an Irish surgeon and
anatomist, Abraham Colles — hence the name “Colles” fracture.
Colles fracture occurs when the broken end of the radius tilts upward.
Other ways the distal radius can
Intra-articular fracture. A fracture that extends into the wrist joint.
(“Articular” means “joint.”)
Extra-articular fracture. A fracture that does not extend into the joint is
called an extra-articular fracture.
When a fractured bone breaks the skin, it is called an open fracture.
These types of fractures require immediate medical attention because of
the risk for infection.
When a bone is broken into more than two pieces, it is called a comminuted
It is important to classify the type
of fracture, because some fractures are more difficult to treat than others.
Intra-articular fractures, open fractures, comminuted fractures, and displaced
fractures (when the broken pieces of bone do not line up straight).are more
difficult to treat, for example.
Sometimes, the other bone of the
forearm (the ulna) is also broken. This is called a distal ulna fracture.
illustration shows some of the types of distal radius fractures.
Reproduced with permission from JF
Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American
Academy of Orthopaedic Surgeons, 2010.
The most common cause of a distal
radius fracture is a fall onto an outstretched arm.
Osteoporosis (a disorder in which
bones become very fragile and more likely to break) can make a relatively minor
fall result in a broken wrist. Many distal radius fractures in people older
than 60 years of age are caused by a fall from a standing position.
A broken wrist can happen even in
healthy bones, if the force of the trauma is severe enough. For example, a car
accident or a fall off a bike may generate enough force to break a wrist.
Good bone health remains an
important prevention option. Wrist guards may help to prevent some fractures,
but they will not prevent them all.
A broken wrist usually causes
immediate pain, tenderness, bruising, and swelling. In many cases, the wrist
hangs in an odd or bent way (deformity).
If the injury is not very painful
and the wrist is not deformed, it may be possible to wait until the next day to
see a doctor. The wrist may be protected with a splint. An ice pack can be
applied to the wrist and the wrist can be elevated until a doctor is able to
If the injury is very painful, if
the wrist is deformed or numb, or the fingers are not pink, it is necessary to
go to the emergency room.
To confirm the diagnosis, the doctor
will order x-rays of the wrist. X-rays are the most common and widely available
diagnostic imaging technique. X-rays can show if the bone is broken and whether
there is displacement (a gap between broken bones). They can also show how many
pieces of broken bone there are.
An x-ray of a normal wrist. (Right) The white arrows point to a distal
Treatment of broken bones follows
one basic rule: the broken pieces must be put back into position and prevented
from moving out of place until they are healed.
There are many treatment options for
a distal radius fracture. The choice depends on many factors, such as the
nature of the fracture, your age and activity level, and the surgeon’s personal
If the broken bone is in a good
position, a plaster cast may be applied until the bone heals.
If the position (alignment) of your
bone is out of place and likely to limit the future use of your arm, it may be
necessary to re-align the broken bone fragments. “Reduction” is the technical
term for this process in which the doctor moves the broken pieces into place.
When a bone is straightened without having to open the skin (incision), it is
called a closed reduction.
After the bone is properly aligned,
a splint or cast may be placed on your arm. A splint is usually used for the
first few days to allow for a small amount of normal swelling. A cast is
usually added a few days to a week or so later, after the swelling goes down.
The cast is changed 2 or 3 weeks later as the swelling goes down more, causing
the cast to loosen.
Depending on the nature of the
fracture, your doctor may closely monitor the healing by taking regular x-rays.
. If the fracture was reduced or thought to be unstable, x-rays may be taken at
weekly intervals for 3 weeks and then at 6 weeks. X-rays may be taken less
often if the fracture was not reduced and thought to be stable.
The cast is removed about 6 weeks
after the fracture happened. At that point, physical therapy is often started
to help improve the motion and function of the injured wrist.
Sometimes, the position of the bone
is so much out of place that it cannot be corrected or kept corrected in a
cast. This has the potential of interfering with the future functioning of your
arm. In this case, surgery may be required.
Procedure. Surgery typically involves making an incision to directly
access the broken bones to improve alignment (open reduction).
plate and screws hold the broken fragments in position while they heal.
Depending on the fracture, there are
a number of options for holding the bone in the correct position while it
Metal pins (usually stainless steel or titanium)
Plate and screws
External fixator (a a stabilizing frame outside the
body that holds the bones in the proper position so they can heal)
Any combination of these techniques
fractures. Surgery is required as soon as
possible (within 8 hours after injury) in all open fractures. The exposed soft
tissue and bone must be thoroughly cleaned (debrided) and antibiotics may be
given to prevent infection. Either external or internal fixation methods will
be used to hold the bones in place. If the soft tissues around the fracture are
badly damaged, your doctor may apply a temporary external fixator. Internal
fixation with plates or screws may be utilized at a second procedure several