Distal Radius Fractures

Symptoms: Common signs and symptoms of a distal radius fracture may include:

• Pain, swelling, and tenderness around the wrist joint.
• Difficulty or inability to move the wrist or hand.
• Visible deformity, such as a bump or angulation at the wrist.
• Bruising or discoloration of the skin over the fracture site.
• Numbness or tingling in the fingers, indicating possible nerve involvement.

Distal radius fractures are common injuries involving the distal (lower) end of the radius bone in the forearm, near the wrist joint. These fractures can occur due to a variety of traumatic events, such as falls onto an outstretched hand, direct blows to the wrist, or high-impact accidents. Distal radius fractures are particularly common in patients over the age of 60 due to age-related changes in bone density and increased risk of falls.

Causes: Distal radius fractures often occur as a result of traumatic events, such as:

• Falls onto an outstretched hand, especially from a standing height or higher.
• Direct blows or impact to the wrist, such as during sports activities or motor vehicle accidents.
• Twisting or bending injuries to the wrist joint, particularly in activities that stress the forearm and wrist.

Diagnosis: Distal radius fractures are typically diagnosed based on a combination of clinical evaluation, physical examination, and imaging studies, such as X-rays. X-rays can help confirm the presence of a fracture, determine the extent of displacement or angulation, and guide treatment decisions.

Treatment: The treatment approach for distal radius fractures depends on factors such as the severity of the fracture, degree of displacement, patient’s age, activity level, and overall health. Treatment options may include:

Closed Reduction and Casting: For nondisplaced or minimally displaced fractures, the bone fragments may be realigned (reduced) using manual manipulation (closed reduction) under local anesthesia, followed by immobilization in a cast or splint to allow for healing.

Open Reduction and Internal Fixation (ORIF): For more complex or displaced fractures, surgery may be necessary to realign the bones and stabilize them with screws, plates, or other implants (internal fixation). This procedure, known as ORIF, is performed under general or regional anesthesia and allows for more precise alignment and stability of the fracture fragments.

External Fixation: In some cases, an external fixation device (such as pins or screws inserted into the bone and connected to an external frame) may be used to stabilize the fracture temporarily, particularly in cases of severe soft tissue injury or open fractures.

Rehabilitation: Following treatment for a distal radius fracture, rehabilitation and physical therapy are essential components of the recovery process. Rehabilitation may include exercises to improve range of motion, strength, and function of the wrist and hand, as well as activities to promote healing and prevent stiffness or complications.

Surgery for a distal radius fracture, mainly when the fracture is severe or significantly displaced, may be necessary to realign the bone fragments and stabilize the fracture to promote proper healing and restore function to the wrist joint.

Surgical options for a distal radius fracture:

Open Reduction and Internal Fixation (ORIF): ORIF is the most common surgical procedure for treating severe or displaced distal radius fractures. During ORIF, Dr. Pournaras will make an incision over the fracture site to directly access the bone fragments.

The fractured bones are then carefully realigned (reduced) into their proper position using surgical instruments and techniques. Once the bones are aligned, they are stabilized using specialized implants such as plates, screws, pins, wires, or external fixation devices. The implants are placed to hold the bone fragments in position while they heal, allowing for early mobilization and rehabilitation.

ORIF may be performed under general anesthesia or regional anesthesia (nerve block), depending on the patient’s preference and the fracture’s complexity.

External Fixation: External fixation is another surgical technique used to stabilize severe or complex distal radius fractures. During external fixation, Dr. Pournaras will place pins or screws into the bone fragments on either side of the fracture site. These pins or screws are then connected to an external frame, which holds the bones in proper alignment and provides stability while they heal.

External fixation may be used as a temporary stabilization measure, particularly in severe soft tissue injuries, open fractures, or fractures with significant swelling.

Arthroscopically Assisted Reduction and Fixation: In some cases, arthroscopic techniques may be combined with traditional ORIF to assist with fracture reduction and visualization of the joint surface. Arthroscopic-assisted reduction and fixation allow for minimally invasive surgery and may help improve outcomes by facilitating more accurate reduction and restoration of joint congruity.

Bone Grafting: In cases of significant bone loss or comminution (fragmentation) of the distal radius, bone grafting may be necessary to fill in gaps and promote bone healing. Bone grafts may be harvested from the patient’s body (autograft) or obtained from a donor (allograft) and placed at the fracture site to support bone union and stability.

After surgery for a distal radius fracture, patients typically undergo a period of immobilization in a splint or cast to protect the surgical repair and allow for initial healing. Physical therapy and rehabilitation exercises are then initiated to restore the wrist joint’s range of motion, strength, and function. The specific rehabilitation protocol will depend on the type of surgery performed, the severity of the fracture, and the individual patient’s needs and goals.

Overall, surgery for a distal radius fracture aims to achieve proper alignment, stability, and function of the wrist joint, allowing patients to regain mobility and return to normal activities with minimal long-term effects. 

Recovery after surgery for a distal radius fracture involves several phases, including immediate postoperative care, immobilization, rehabilitation, and gradual return to normal activities. The specific timeline and protocols may vary depending on the type of surgery performed, the severity of the fracture, and individual patient factors. Here’s an overview of what to expect during the recovery process:

Immediate Postoperative Care: Patients are typically monitored in the recovery room until they are awake and stable after surgery. Pain management is a priority during this time, and patients may receive pain medications as needed to keep them comfortable. The surgical incisions are dressed, and the affected arm may be placed in a splint or cast to immobilize the wrist and protect the surgical repair.

Immobilization: Immobilization of the wrist is essential for allowing the bones to heal properly after surgery. Depending on the type of surgery performed and the stability of the fracture, patients may be placed in a cast, splint, or external fixation device for several weeks to months. During this time, keeping the wrist elevated above heart level is essential to reduce swelling and promote circulation.

Rehabilitation: Once the initial immobilization period is complete, patients begin a structured rehabilitation program to restore range of motion, strength, and function to the wrist joint.

Physical therapy exercises may include gentle stretching, passive and active range of motion exercises, and strengthening exercises for the muscles surrounding the wrist and forearm. Patients may also undergo manual therapy techniques, such as joint mobilizations and soft tissue massage, to improve mobility and reduce stiffness in the wrist. Rehabilitation typically starts with supervised therapy sessions and may progress to a home exercise program as the patient’s strength and function improve.

Gradual Return to Activities: As the wrist continues to heal and rehabilitation progresses, patients gradually increase their activity level and return to normal daily activities. Depending on the type of surgery performed and the patient’s progress, activities such as driving, lifting, and sports participation may be gradually reintroduced over several weeks to months. It’s essential for patients to follow the medical recommendations and avoid activities that could put excessive stress on the healing wrist joint, particularly during the early stages of recovery.

X-rays may be taken periodically to evaluate the alignment and healing of the fracture and ensure that the surgical repair remains stable. Patients may continue with maintenance exercises and lifestyle modifications to support long-term joint health and prevent future injuries.