Anatomy
Distal radius fractures usually occur when someone falls hard on their arm or directly on their outstretched hands. Of course, this bone can also break in bike accidents, car accidents, skiing or snowboarding accidents, etc.
The ulna also sometimes breaks, and in this case the fracture is known as a “distal ulna fracture”.
Symptoms
A distal radius fracture usually results in instant tenderness, pain, bruising, and inflammation. Oftentimes the wrist will appear physically deformed, hanging or jutting out in an odd way.
Diagnosis
Distal radius fractures are very common. In fact, the radius is the most commonly broken bone in the arm. The break usually happens when a fall causes someone to land on their outstretched hands. It can also happen in a car accident, a bike accident, a skiing accident, and similar situations.
Sometimes, the other bone of the forearm (the ulna) is also broken. When this happens, it is called a distal ulna fracture.
Symptoms
A broken wrist usually causes immediate pain, tenderness, bruising, and swelling. Frequently, the wrist hangs in an odd or bent way (deformity).
Diagnosis
In order to fully evaluate the injury, your physician will take X-rays of your wrist.
Fractures extensive enough to go into the joint are known as “intra-articular fractures”, whereas those that do not run into the joint are “extra-articular fractures”. The word “articular” here signifies “joint”. Bones fractured into multiple pieces are known as “comminuted fractures”.
Determining the exact type of the fracture is crucial because this will in turn determine the type of treatment needed. For instance, intra-articular fractures are more challenging to treat than extra-articular ones. Likewise, fractures that break the skin (open fracture) and those that break the bone in many pieces (comminuted fracture) are also more difficult.
Risks
Wrist fractures can become more complex and risky depending on the patient themselves. For instance, patients with lower bone density (osteoporosis) are not only more at risk for getting fractures in the first place, but their injuries can also be more severe. In fact, a lot of wrist fractures in people above age 60 are from falls that happened while they were just standing.
Distal radius fractures can of course occur in healthy bones, but the trauma to the wrist must be strong enough. For instance, certain car accidents and skiing incidents may involve force that is enough to break a wrist.
Treatment Options
Immediate Treatment
Milder injuries may be able to await treatment until the following day, but those that are very painful and/or involve a visual deformity (including if the fingers lose their color) will need an immediate trip to the ER.
In the meantime, injuries that are not too painful and look visibly okay may be able to await treatment. If you choose to wait, stabilize your wrist with a splint and apply an ice pack to help keep down swelling. Try to keep it elevated as well.
Non-surgical Treatment
Surgery is not necessary in many cases, but the available non-surgical treatments will depend on the type of fracture as well as your age and daily activities.
If the fractured bone is still in decent alignment, the wrist may be put in a cast to allow it to heal. On the other hand, fractured bones that are out of alignment could result in future arm mobility issues and will therefore need to be corrected before a cast is put on.
Splints may be worn for the first couple of days to make room for minor swelling (this is normal), and after that a cast is typically put on. As swelling continues to go down over the following weeks, the cast will need to be changed (otherwise it just gets loose and ineffective). In order to monitor the healing process, your doctor may take periodic X-rays. If the fracture is healing well and is stable, not as many X-rays will be needed.
The healing process with the cast typically takes about six weeks, after which the cast can be removed. At this time, your doctor may begin physical therapy to help you regain mobility and flexibility.
Surgical Treatment
The fractured bone is sometimes so out of position that surgical intervention is needed before it can be left to heal. Otherwise, the future movement and use of your arm and wrist may be compromised.
There are a variety of surgical options here, largely depending on the type of fracture and the extent of the injury. For example, metal pins, plates, screws, an external fixator (a stabilizing device where the bulk of the hardware stays outside the wrist) and/or a specially-made cast are all different options that may be selected.
Recovery from Surgery
Your doctor will go over the details with you, but generally speaking, most wrist fracture pain will linger for anywhere between a few days to a few weeks. Over-the-counter medications, ice packs and keeping the arm elevated have all been known to help the recovery process.
During this time it is important that splints and casts be kept dry (cover it with a plastic bag when necessary and try using a hair dryer if it does get wet). The actual surgical incision should be kept dry and clean for at least five days or until the stitches are removed.
Fortunately, most wrist fracture patients do eventually return to all of their previous activities without issue. Nevertheless, this will depend on the location and severity of the fracture as well as the type of treatment. Physical therapy is very helpful in getting patients back to their former activities, so it is important to listen to your doctor’s recommendations for this. Physical therapy usually starts between a few days to a few weeks after surgery or when the cast is removed. More strenuous activities, like sports, can usually be resumed within three to six months.
Most patients will experience some level of wrist stiffness, but this too should gradually go away within a month (or two) after the cast is removed or surgery is completed. That said, complete recovery can take up to two years.
Aside from stiffness, general recovery should take around 12 months. Until then there may be some mild pain during more strenuous activities, like sports. Patients who are older (50 years old and up) and/or who have more severe injuries may experience some lasting symptoms for years longer or even throughout their lifetime. However, these symptoms are usually tolerable and don’t get in the way of everyday life, much less the wrist’s overall function.
