Distal Radius Fracture

Basic Anatomy

A distal radius fracture is commonly called a wrist fracture or a broken wrist. The radius is one of the two long bones in the forearm that run from the elbow to the hand. Distal means the farther (wrist) end of the bone. The upper part of your radius (closer to your elbow) is part of your elbow joint, and the lower part of your radius (closer to your hand) is part of your wrist joint. Muscles in both your upper arm and the forearm attach to your radius or hand to move your elbow, wrist, and hand. There are two important arteries near your wrist on the side of your palm: the one on the thumb side of your arm is called the radial artery and the one near your small finger is called the ulnar artery. There are also two main nerves that run on the palmar side of your hand. These provide feeling in your fingers and hand.

Skeleton model showing the radius and how it contributes to the wrist joint. — Figure 1: Skeleton model showing the radius (one of two bones in the forearm) and how it contributes to the wrist joint. The distal radius area is the location of the injury.

Figure 2: Normal x-ray showing the distal radius and how it contributes to the wrist joint. The labeled area is the location where this type of fracture occurs. Sometimes the distal ulna bone breaks at the same time as the distal radius.

Mechanism and Epidemiology

Distal radius fractures are the most common type of broken bone. They are the most common fracture in children under 16 and also often occur in older women due to osteoporosis (weakening of your bones). Younger patients are often injured from high-energy accidents such as falling off a skateboard. In older patients, distal radius fractures are usually caused by a fall from standing height onto an outstretched hand. Other types of trauma can also break the wrist.

Figure 3: X-rays showing three different views of a distal radius fracture. The red arrows point to the breaks in the bone.

Initial Treatment

Most of the time if you break your wrist it hurts very badly and you cannot use your hand very well. When you go to the emergency room, urgent care, or your doctor's office, they will get x-rays of your wrist and other parts of your arm to look for breaks. If your bone is crooked, a doctor will move the bones back into place. Doctors call this a "reduction." Your arm may be hung up in the air for a while—sometimes with a weight on the elbow. This may help pull your bones back into place and makes the reduction easier. Once your bone is in a better position, you will be placed in a cast or a splint. X-rays will be taken to make sure the splint is keeping your bones in position after the reduction. Generally, if your bones are in a good position you will be sent home with a sling. You will need to make a follow-up appointment to see an orthopaedic surgeon to talk about the options for treating your broken wrist.

If your bone poked through your skin or if the doctors are unable to get a good reduction, you may need to be admitted to the hospital. In that case, you may require surgery, antibiotics, more scans (images of your broken bone), or other treatment. It is also important to let your doctor know if your hand or fingers are numb (you are unable to feel your hand or fingers). This might also require admission to the hospital.

General Treatment

Your treatment is based on the pattern of your break. Some breaks can be put back into place so well that they do not require surgery. You will be kept in a splint or cast while your break heals. During this time, you will not be able to bear weight (lift, push, pull) until your bone heals (about 6 -12 weeks). You may also be seen several times for x-rays to make sure your bones still line up well. Your cast or splint may need to be changed if it becomes loose, dirty, or seems to not be working well. If you have any questions or concerns about your cast or splint, you should ask your doctor.
If your wrist is broken in several pieces, a bone poked through the skin, or your fracture cannot be held in a good position with the splint or cast, you may require surgery. Surgery is done by making one or more cuts on the skin near your wrist. A plate and screws are often used to hold the fractured pieces in place. Sometimes pins and even bars that come out of the skin are used to hold the broken bones in a good position. Surgery requires either general anesthesia or local anesthesia (numbing medication) and sedation (making you sleepy). Once the broken wrist is held together, the cut will be closed with stitches.

Figure 4: The left x-ray shows a distal radius fracture treated without surgery in splint after reduction. The x-ray on the right shows a healed distal radius fracture treated in a splint without surgery.

Figure 5: Image on the left shows location of the incision made during surgery. X-ray on the right shows a distal radius fracture after surgery with plate and screws.

Figure 6: X-rays of a wrist fixed with a temporary spanning plate. After 12 weeks, the plate was removed and the fracture was healed.

X-ray of a wrist treated with plates and screws, pins, and an external fixator. — Figure 7: X-ray of a wrist treated with plates and screws, pins, and an external fixator (a device to hold the bones in position while they heal).

Post-operative Care

After surgery, you may be placed in a splint or cast. You will likely be instructed to limit how you move your wrist or use your arm to lift, push, or pull anything. You will be allowed to move your fingers. After a few weeks, your splint or cast is typically removed, and your stitches may need to be removed. You may still have to wear a cast or a removable splint. If pins were placed through or under the skin, they may need to come out. This can commonly be done in the clinic by your surgeon or other staff.

It is important to move your fingers, elbow, and shoulder after surgery to prevent stiffness. Keeping your hand elevated will help with pain and swelling. Rubbing or massaging your fingers may help decrease your pain as well. Applying ice or a cold pack to your wrist can help decrease pain (even through a cast).

Your surgeon will let you know what specific activities you can and cannot do after surgery. Sometimes, you can get back to typing and writing even while wearing a cast or splint. You can ask your surgeon or their staff if this is okay to do.

After your cast or splint is removed, you may need therapy to help you move your fingers, hand and wrist. Sometimes you can do therapy on your own. You can ask your surgeon if you will need therapy for your wrist after it has healed.

Long Term

After a distal radius fracture, your wrist may be stiffer or weaker than before. This is very common. You may develop arthritis in your wrist. This can cause stiffness and pain. You may also feel that your wrist is bigger, wider, or has a bump.

Some fractures do not heal, heal partially, or heal crooked and cause some pain. If that happens, you may need surgery. If your break was fixed with plates and screws, they may be removed later after everything has healed. Removing the hardware may or may not take away any pain in your wrist. Pain is usually caused by thick scar and pulling of the skin or deep tissues.

It is common to have some numbness over your wrist near the scar. Rarely, one of the tendons to the hand (tissues that connect muscles to bone) can tear after a wrist fracture. Tendon injuries can occur with or without surgery, and may make it hard to move your fingers or wrist. If this happens, you may need surgery to fix. After breaking their wrist, most people get back to doing most of their activities, but the wrist usually feels or works a little differently compared to before it was injured.

Physical Therapy Videos - Forearm

More Information

American Academy of Orthopedic Surgeons

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David M. Keller, DO; Jaclyn Jankowski, DO; and Frank A. Liporace, MD
Edited by the OTA Patient Education Committee and Steven Papp, MD (section lead)
X rays and images from the personal collections of Dr. Keller, Dr. Jankowski, Dr. Liporace and Christopher Domes, MD