Raleigh Hand Center
3701 Wake Forest Rd
Raleigh, NC 27609
What is a distal radius fracture?
A distal radius fracture is a common type of wrist injury. These fractures can occur from a variety of trauma ranging from a fall at home to a major motor vehicle collision. The distal radius is the portion of the radius bone just below the wrist joint. As we age, the metaphyseal bone of the distal radius loses bone mass and becomes more prone to injury, particularly in post-menopausal women and people with osteoporosis. The distal radius may fracture as a result of a slip and fall in these cases. Younger patients with healthier bones may fracture the distal radius after high-energy trauma. In most cases, restoring the function of the hand, wrist and forearm is dependent on satisfactory healing of this injury.
The radius and ulna bones are the skeletal foundation of the forearm. At the wrist, the radius is much larger than the ulna and supports about 80% of the force transmitted across the joint. The ulna is much smaller that the radius at this level. A small fracture at the end of the ulna (ulnar styloid process) is also commonly seen with distal radius fractures.
What are the treatment options?
The treatment plan will depend on the severity of the fracture as noted on the x-rays and the patient’s medical condition, activity level, and desires. The distal radius bone reliably heals after a fracture; the main question is whether it will heal in an acceptable position. Most people have fractures which are well-aligned, and, therefore, do not require surgery. Treatment in these cases is typically rest and protection in a cast or brace for several weeks. Follow-up x-rays are obtained in clinic to evaluate how the fracture is healing.
Some fractures can be re-aligned well without surgery, called “closed reduction”, and those patients can also be treated successfully non-operatively. This is performed either in the office or emergency room using an injection of a local anesthetic (lidocaine). After the bones are "set" a plaster splint is molded to the wrist and forearm to maintain the alignment. Therapy is often helpful in improving wrist range of motion and strength after the fracture heals. It may take several months for strength and range of motion to improve to maximal, even with therapy. Sometimes people do not regain full range of motion or strength after a distal radius fracture.
Some patients have fractures which are more severe and the alignment of the fracture is not satisfactory. Depending on the patient’s health and activity level, surgery may be advised to improve and maintain the alignment.
What do the x-rays look like?
X-rays below demonstrate a non-displaced distal radius fracture. Notice the "hairline crack" through the end of the radius bone (red arrows). The ulnar styloid is not fractured in this case.
Below are x-rays of a displaced distal radius fracture and ulnar styloid fracture. The fracture is in multiple pieces, which is referred to as "comminuted."
What is involved with surgery?
The surgery is performed on an outpatient basis in the operating room. Either regional anesthesia (brachial plexus nerve block) or general anesthesia is used to prevent pain during the operation. During the surgery, I improve the alignment of the fracture and use an implant to stabilize the pieces. In most cases, I use a low-profile plate and screws to fix the bones internally. This is called “open reduction and internal fixation” and requires an incision at the wrist. The orthopaedic hardware is covered by the skin and soft tissues of the wrist and rests against the surface of the bone. Rarely, an external frame and/or pins are used to keep the bones aligned, depending on the fracture type. The external frame and pins are temporary, and are removed after a few weeks once the bones have healed. This is called “external fixation” and "percutaneous pinning."
Surgery does not really "heal" the fracture; it simply allows the bones to be held in good alignment while the body bridges the fracture site with new bone. This healing process takes a few weeks.
X-rays below demonstrate the surgical hardware commonly used (volar plate) with improved alignment of the distal radius fracture. In most cases, the ulnar styloid fracture does not require hardware fixation.
What can I expect after surgery?
Rest and elevation of the hand to the level of the heart is very import for the first few days after surgery to reduce swelling. I encourage finger and thumb range of motion to help prevent digit stiffness. Shoulder and elbow range of motion exercises are also important to help prevent stiffness in these joints. The first few days after surgery can be very painful, and narcotic medications will be prescribed to help. These should be weaned as the pain improves over time.
Your wrist and possibly elbow will be protected in a plaster splint which will be removed in clinic along with the skin sutures at about 10-14 days. At this point, most patients can begin gentle wrist range of motion with the oversight of a therapist. However, some patients need an additional few weeks of casting to protect the repair, depending on the severity of the fracture. I recommend avoiding heavy lifting, pulling, pushing or gripping until the fracture is solidly healed, approximately 6-8 weeks after surgery.
Pain, swelling, and stiffness gradually improve over time. Most patients can return to more normal function at about 2-3 months post-operatively, but maximum improvement can take 6-12 months. Recovery time varies among patients, depending on the severity of the injury, possible complications, and pain tolerance of the patient. Occasionally, patients have residual stiffness and “aching” in the wrist after treatment. Arthritis, also known as degenerative joint disease, may develop in the future if the initial injury damaged the joint surface. My goal is to help each patient obtain the most function possible after the injury.
What are the complications from surgery?
No surgery is risk-free. However, the risk of major complications from distal radius fixation is low. Possible complications include pain, bleeding, infection, swelling, stiffness, nonunion, malunion, implant-related tendon irritation, hardware failure, and damage to the surrounding nerves and blood vessels. A fracture which fails to unite is known as a nonunion. A fracture which heals with deformity is known as a malunion. Other complications are also possible but are uncommon.
What can I do to improve my results?
Adequate nutrition is important during the healing and recovery process. I recommend a diet rich in protein and calcium and an adequate intake of calories per day while your body is healing. If you smoke, eliminating tobacco products will decrease your risk of nonunion, delayed healing, and infection. Complying with the therapist’s recommendations is very important to maximize your result. I work closely with hand therapists at the Raleigh Hand Center in order to improve range of motion and strength.
Interestingly, taking Vitamin C after a wrist fracture may reduce the chance of developing nerve complications and pain syndromes. I recommend taking 500 mg of Vitamin C daily for 2 months after the injury.
How can I prevent this from happening again?
Some distal radius fractures are related to reduced bone density or osteoporosis. Most people with osteoporosis can decrease their fracture risk with lifestyle changes and medication. Talk to your primary care physician about the need for a bone density study at your next appointment.
How do I schedule an appointment?
Please call 919-872-3171 or visit www.raleighhand.com. Dr. Erickson is a hand and upper extremity specialist and treats patients with hand and wrist injuries from the NC Triangle area including Raleigh, Durham, Chapel Hill, Cary, Apex, Morrisville, Garner, Wake Forest, Knightdale, Clayton, Smithfield, Fuquay-Varina, and Holly Springs, NC. For patients with a long drive, treatment can often be coordinated with a provider closer to home after a few visits to Raleigh.
Disclaimer: This material is intended for general reference only and does not replace an evaluation by a physician.
If you have an injury to your hand or wrist, please call the Raleigh Hand Center to request an evaluation by Dr. Erickson, a hand and upper extremity specialist.
Copyright 2014 Erickson Hand Surgery
Raleigh Hand Center
3701 Wake Forest Rd
Raleigh, NC 27609