When people fall, they usually reflexively catch themselves with their hand. This often results in a distal radius fracture. The spoke of the forearm near the wrist is broken, which is why it is often referred to as a broken wrist. Which treatment helps and are long-term effects possible?
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Quick Overview: Distal Radius Fracture
Definition: The distal radius fracture is the most common bone fracture in humans. This causes the spoke in the forearm to break near the wrist. The fracture usually occurs when you use your hand to support yourself when you fall.
Symptoms: Pain in the joint of the hand, swelling and restricted movement are typical for lower spoke fractures.
Therapy: The fracture is treated either with a plaster cast or surgical stabilization.
Healing time: In the majority of cases, the fracture heals in four to six weeks.
Diagnosis: An x-ray helps determine the fracture and its extent.
Complications and long-term consequences: Possible consequences include functional limitations of the hand, sensory disturbances and persistent pain.
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What is a Distal Radius Fracture?
The distal radius fracture is the most common fracture in humans. Broken bones are particularly common in children and older people.
The fracture affects the radius of the forearm near the wrist. Together with the ulna, the radius forms the forearm skeleton and part of the wrist.
Distal refers to the location of the fracture and means something like “away from the body”. It is much rarer for the radius to break near the elbow; experts then speak of a proximal, i.e. close to the body, radius fracture.
A fall onto an outstretched arm is the typical cause of a radius fracture. Depending on whether someone fell on their bent or extended hand, a distinction is made between a flexion fracture or an extension fracture. When caught with the palm of the hand, an extension fracture is typical.
Possible accompanying injuries affect the tendons and ligaments of the wrist as well as the carpal bones.
Distal radius fracture: What are the symptoms of a broken wrist?
Severe pain in the wrist immediately after an accident, which increases with movement or strain, and gradually increasing swelling are usually the first indications of a possible fracture.
Sometimes the misalignment of the broken bones is directly visible. With a distal radius fracture, the hand often points downward. In addition, a bruise (hematoma) may be visible or a crunching sound may be heard when moving. Movement is also restricted.
In some cases, broken ends protrude from open wounds. These can pierce the skin due to massive trauma. Experts also speak of an open or complicated fracture. There is a risk of infection.
In any case, you should avoid putting any further strain on the injured wrist and keep the wrist stationary and as high as possible until further treatment. This avoids unnecessary pain and the development of severe swelling.
Causes of a distal radius fracture
A radius fracture is usually the result of a fall. Due to reduced bone density, people with osteoporosis and older people are at risk of suffering a broken spoke, even from occasional, harmless falls.
For children and younger adults, bicycle or sports accidents (e.g. inline skating or mountain biking) are the main cause of accidents.
Therapy: How is a distal radius fracture treated?
How a distal radius fracture is treated depends, among other things, on:
- whether there is joint involvement (intra-articular fracture),
- whether the fracture ends are shifted,
- how old the person concerned is and
- what the bone mass is like.
The aim of treatment is to restore hand mobility and avoid long-term consequences. In principle, a distinction is made between conservative therapy, i.e. immobilization using a plaster splint, and surgical treatment.
Conservative therapy: Plaster helps with uncomplicated wrist fractures
A plastic or plaster splint is mainly used if there is no joint involvement and the ends of the fracture are not displaced too much from one another. If these are only slightly offset, they can be realigned to one another during a reduction.
Since moving broken bones is painful, the administration of painkillers or anesthesia is necessary. Anesthesia of the hernia gap (hernia gap anesthesia) can also suppress the pain during reduction.
The cast is then worn for around four to six weeks. A check-up will then be carried out to ensure that the bone has grown together correctly.
Surgery for distal radius fracture
In some cases, conservative treatment is not enough to repair the fracture. For example, an operation is necessary if:
there is involvement of the joint,
the fracture ends are massively displaced,
the bone is shattered into many fragments (comminuted fracture),
the nerves or blood vessels are injured or
when the bone has pierced the skin.
Depending on the type of fracture, different surgical procedures can be used to treat the fracture. The aim is always the anatomical reconstruction and restoration of function of the wrist.
External fixator: In open comminuted fractures, the distal radius fracture is often stabilized with an external fixator. This is a holding device attached to the outside of the arm that is connected to the bone via long screws. The frame holds the individual bone fragments in place and thus enables a smooth healing process. The fixator must be removed after a few weeks.
Osteosynthesis: Stabilizing the fracture site using wires, nails and screws is often used. If a metal plate is used, this is also referred to as plate osteosynthesis. Osteosynthesis has the advantage that inserted plates and screws do not necessarily have to be removed after the healing process has been completed. Whether the material used needs to be removed in another operation after osteosynthesis depends on various factors such as age.
X-ray confirms the diagnosis of the radius fracture
Doctors often recognize a broken spoke from the existing misalignment. Nevertheless, an additional x-ray is required so that the position of the fragments relative to one another can be assessed. In some cases, magnetic resonance imaging (MRI) or computer tomography (CT) can also be useful, for example to rule out ligament injuries.
A radius fracture can be diagnosed through a physical examination coupled with an x-ray. Complicated forms of spoke fractures, such as a comminuted fracture or a fracture that extends into the articular surface, can also be recognized in this way.
Distal radius fracture: long-term consequences and chances of recovery
If a distal radius fracture is diagnosed early and treated accordingly, the chances of recovery are good. The fracture usually heals within four to six weeks. However, in severe cases, healing may take longer.
In rare cases, complications are possible, including:
an adhesions of the bones in a misalignment
a secondary dislocation (displacement of the fracture ends after medical correction)
Movement and functional restrictions
Infections (in open fractures)
Nerve damage (and as a result of sensory loss in the hand)
In addition, a complex pain syndrome, also known as Sudeck’s disease, develops more frequently as a result of a distal radius fracture than with other injuries to the arms or legs. After trauma or surgical treatment, severe chronic pain occurs in the affected region.
Follow-up care for a distal radius fracture
Follow-up care is essential for patients with a distal radius fracture. It ensures that the fracture heals well and mobility is restored.
If the joint and forearm are in a cast and immobilized, the neighboring joints such as the fingers or elbow should still be moved several times a day. This promotes blood circulation and the healing process and does not put any strain on the diseased joint.
It is also recommended to seek physiotherapy after the immobilization phase. It can help you regain full mobility.
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