A distal radius fracture (ICD code: S52.5) is also commonly known as a wrist fracture . It is actually a fracture (medical fracture) of the radius , which is also called the radius in technical terms. Theulna, the second forearm bone, is not injured in a radius fracture, otherwise it is referred to as a distal forearm fracture.
Distal and proximal are terms used to classify and categorize extremities more precisely. Here
- distal stands for away from the body (closer to the fingers in the arm) and
- proximal for close to the body (closer to the shoulder on the arm).
The special feature of distal radius fractures is that the wrist is often also affected, resulting in a risk of impaired wrist mobility. The distal radius fracture differs from a simple radius fracture
- in terms of the location of the fracture
- and in terms of treatment.
If the radial fracture impairs or damages the wrist, surgery is usually required.
Conservative treatment, i.e. simple immobilization in plaster without surgery, is only possible for very simple fractures (simple radius fracture). However, it is recommended if the radius is fractured without malalignment and impairment of the joints.
The radius is one of the two forearm bones © FGWDesign | AdobeStock
A distal radius fracture is invariably caused by an accident, most commonly a fall on the outstretched hand. This common bone injury also causes pain in the affected area, i.e. the wrist. This pain is often still mild immediately after the accident and intensifies and worsens as the swelling increases and a bruise forms.
There is also a significant restriction in the mobility of the wrist, which can be attributed to the usually pronounced swelling and pain. Increasing sensitivity to touch and pain when pressure is applied to the joint are also typical signs of a wrist fracture.
In addition, the affected arm can often no longer exert as much force as normal. Sensory disturbances can also occur, for example if a nerve is pinched or constricted as a result of the fracture.
Finally, depending on the severity of the fracture, a deformity may also be visible, giving the wrist an abnormal appearance.
In extreme cases, there may be open skin injuries and exposed parts of the bone, which is also referred to as an "open fracture". This is very serious and is generally an indication for surgical treatment.
The symptoms summarized again at a glance:
- Pressure pain
- Pain on movement
- Swelling of the forearm or wrist
- Possible misalignment
- Functional disorders
- loss of strength
- Sensory disturbances
- Skin injuries and exposed bone parts
Fractures of the radius usually result from catching a fall forwards with the hands. When falling, most people instinctively stretch their hands forward to avoid falling on their face. Depending on the angle of the fall, the severity of the impact and the speed, a fall can quickly result in a fracture. In younger people, serious falls during sport are usually the cause. Above all
- contact sports such as soccer, handball or basketball and
- jump-centered sports such as high jump or long jump
- fall-prone sports (inline skating, skateboarding)
have an increased risk. However, distal radius fractures are also common in low-contact sports such as jogging or cycling when tripping and falling due to speed and uneven terrain (e.g. in the forest).
In a distal radius fracture, it is not the bone of the wrist that breaks, but the radius close to the wrist © yodiyim / Fotolia
In older patients, even minor falls can lead to a fracture due to the often lower bone density(osteoporosis).
Bone density decreases with increasing age without there necessarily being any pathological bone changes. The bones therefore become physiologically more unstable with age (i.e. without a pathological change) and can break more easily. Strength training for seniors can help here and can lead to a strengthening of the bone structure.
However, in the case of a pathological reduction in bone density, osteoporosis, the bone is weakened beyond the normal (physiological) level and as a result is extremely susceptible to fractures. For this reason , even minor falls are sometimes enough to cause fractures in old age. Radius fractures after falls from a standing position are very common.
Fractures of the radius near the wrist are classified into two subtypes :
- Colles fracture: impact with the outstretched hand
- Smith fracture: impact with the flexed hand.
The Colles fracture accounts for around 90 percent of all radius fractures and is therefore much more common. Although the Smith fracture is much rarer, it requires surgical treatment in the vast majority of cases. This is because the Colles fracture is often stable and can be treated with a plaster cast, whereas the Smith fracture is unstable and keeps shifting despite treatment with a plaster cast. Conservative treatment of the Smith fracture almost invariably leads to wrist arthrosis, which is due to incorrect or non-healing.
A fracture of the radius is a matter for trauma surgery and orthopaedics. Patients are often initially treated and examined in the emergency room. First of all, a report is made on the history and the mechanism of the accident, then the forearm is palpated to check whether there is any
- swelling,
- tenderness or
- bruising
are present. Sometimes a crackling sensation can also be detected during the examination, which is another strong indication of a bone fracture. In extreme cases, a clear misalignment of the bone and joint can also be detected, which is practically proof of a bone fracture. During the initial examination, it is also important to check the blood circulation and sensation of the hand in order to rule out vascular and nerve injury.
A radial fracture without malalignment often delays the diagnosis, as many symptoms are absent in this case. As a rule, the type of underlying fracture can be shown beyond doubt by means of an X-ray.
If a complicated fracture is suspected, a computer tomography (CT) scan is also used in most cases.
In the case of a so-called simple and stable radial fracture, conservative treatment may be sufficient. A stable radial fracture is one in which the fracture ends are well aligned and do not move against each other in a cast. However, regular X-ray checks are important here, initially at short intervals, to monitor the success of the cast treatment and the position of the bones. Immobilization in plaster is usually carried out for six weeks.
In the case of an unstable fracture, however, the fracture ends cannot be repositioned well and there is always a risk that the bone ends will move against each other despite the plaster cast. This is always the case if there is tissue (e.g. tendons) between the bone ends or in the case of the Smith fracture described above. Unstable fractures must always be treated surgically, otherwise there is a risk of wrist arthrosis.
What surgical methods are available for distal radius fractures?
The principle of all surgical procedures (as with the conservative approach) is that the fracture must first be brought back into the correct position by means ofreduction. This position should be the normal position. It is then necessary to fix this position, which can be achieved using different procedures.
- Plaster immobilization: This is possible and indicated if tissue had to be removed from the fracture gap before reduction and the fracture is then in a good and stable position.
- Osteosynthesis procedure: This refers to the fixation and stabilization of the fracture using screws, wires, plates or other devices that are inserted into or onto the body from the outside. Osteo stands for bone, synthesis for connection/union.
The following are examples of the most important osteosythesis procedures:
- External fixator (attachment of an external metal frame)
- Wire osteosynthesis (often used in children, so-called "cribbed wires")
- Screw osteosynthesis
- Plate osteosynthesis (most common procedure)
The most suitable surgical method must be assessed individually in each case.
Metal plates and screws fix a broken radius © Whyona / Fotolia
After the operation, the wrist must rest for an appropriate period of time. In the meantime, the surrounding muscle and joint areas should be specifically loaded again as quickly as possible.
As part of physiotherapy, the movement sequences of the fingers, elbow and shoulder are tested and normalized. Patients should also quickly resume light grip movements and not immobilize their arm completely.
Following the operation, the success of the procedure is also monitored using X-rays . The first admission usually takes place on the first day after the operation, when many patients are still in hospital. In the case of outpatient procedures, appointments for follow-up examinations are made immediately upon discharge. Depending on the findings, an appointment is then made for the next check-up. However, this should always take place after 6-8 weeks at the latest in order to document the healing of the fracture.
The metal support materials used must be removed after a certain time as part of a minor procedure. The plates used in plate osteosynthesis usually remain in the body for at least 12 months, wires and screws are removed earlier. This is due to the fact that wires and screws can break or migrate outwards under load and cause skin damage. This is not usually the case with plates.
The prognosis for treatment depends on the severity of the fracture. If the fracture is severe, there may be subsequent complaints such as
- chronic pain
- loss of strength or
- sensory disturbances
remain. These must then be treated individually.
As a rule, however, a distal radius fracture heals well and no permanent damage remains.
