Distal radius fracture in the adult

The distal radius fracture is a fracture of the radius near the wrist and one of the most common bone fractures in adults. You can find out the most important information about symptoms, diagnosis and therapy here

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© W & B / Jörg Neisel

Distal radius fracture - briefly explained

The distal radius fracture is a fracture of the spoke near the wrist (radius). The cause is usually a fall on the outstretched arm, less often direct violence. The fracture causes pain in the affected area, sometimes a deformity is visible. The doctor can determine the break through the physical exam and x-rays. Depending on the shape of the fracture (with or without involvement of the joint), the course of the fracture, bone substance and the age of the patient, the fracture is either treated with a plaster of paris or surgically positioned and usually fixed with a metal plate. The prognosis of a distal radius fracture is favorable, but consequential damage in the sense of a painful impairment of function or the development of osteoarthritis can occur.

What is a distal radius fracture?

The distal radius fracture is a break (fracture) of the spoke (radius) near the wrist. Distal on the extremities means the region away from the trunk of the body. The radius has two articular surfaces in the direction of the hand: the wrist rests on the large articular surface. This colloquial "wrist" is essentially responsible for the flexion and extension of the hand. The small joint to the distal ulna, around which the radius rotates when the forearm turns, is also important for the function.

The age distribution shows two age peaks, the first at the beginning of school around the age of six, the second around the age of 70. If a fracture occurs from the age of 50, this could indicate the onset of osteoporosis (bone loss). Women are more often affected than men in the second age peak.

With up to 25 percent of all fractures, the distal radius fracture is the most common type of fracture in adults.

Are there differences between the pediatric and the adult distal radius fracture?

  • Pediatric distal radius fracture

In childhood, the fractures are often uncomplicated (compression fracture or Aitken I fracture) in which the ends of the fracture are not clearly shifted or offset. These breaks can usually be treated with a plaster cast or surgically with wires.

  • Adult distal radius fracture

In adulthood, fractures occur much more frequently, in which the ends of the fracture are displaced, i.e. displaced from one another. Fractures involving the articular surface of the wrist are also more common.

This article applies to the distal radius fracture in adulthood.

Types of distal radius fractures: how are distal radius fractures classified?

Doctors divide fractures of the distal radius fracture into extra-articular (outside the articular surfaces) and intra-articular (involving the articular surfaces) according to their location. A "simple" fracture without joint involvement is much more common.

With the distal radius fracture there is the so-called flexion fracture ("Smith fracture") and the extension fracture ("Colles fracture"). The mechanism of falling on a stretched or bent hand plays a role here. The extension of the wrist means bending the hand towards the back of the hand (dorsiflexion = extension). A flexion of the wrist means bending the hand towards the palm of the hand.

Classification of fractures according to extension and flexion fractures:

© W & B / Jörg Neisel

  • Extension fracture = "Colles fracture"

Arises from falling on the palm of the hand. Extension means the stretching of a joint (see above). When stretching the wrist, the hand is bent towards the back of the hand. This is why one speaks of an extension fracture.

The piece of bone facing the wrist is shifted towards the back of the hand.

© W & B / Jörg Neisel

  • Flexion fracture = "Smith fracture"

Falling on the flexed hand causes a flexion fracture. Flexion means the bending of a joint; in the case of the wrist, this is the bending of the hand towards the palm of the hand.

If you fall on the bent hand, the piece of bone facing the wrist slips in the direction of the palm of the hand.

Classification of fractions according to AO classification:

Nowadays (and in order to do justice to the other types of fractures as well), the working group for osteosynthesis (AO) classifies distal radius fractures into three groups:

Type A: fracture outside the joint surfaces (extra-articular)

Type B: fracture with partially existing joint involvement (partially intra-articular)

Type C: fracture with complete joint involvement (intra-articular)

These three classifications A, B and C are subdivided into three further subgroups (1, 2 and 3), which include the involvement of the ulna and the degree of destruction. The additional involvement of the radio-ulnar joint (the joint between ulnar and radius in the distal area) is important for the therapy decision and the function, since remaining misalignments in this part of the joint can significantly influence the function of the turning movement.

Causes: How did a distal radius fracture come about?

The cause of a distal radius fracture is almost always a fall in which one tries to support oneself with the hand. Since you usually try to catch a fall with an outstretched arm and palm in front, a Colles fracture occurs particularly often (see forms of distal radius fracture). Older people are more likely to have weakened bones, which makes it easier for them to break. Younger people usually require greater force (trauma), such as a fall while inline skating without wrist protectors.

Symptoms: What symptoms does a distal radius fracture cause?

If a bone breaks, pain occurs in the affected area. Trying to twist your wrist or forearm in particular increases the pain. This can also lead to swelling and bruising in the wrist area. Sometimes a misalignment can already be visible. The functionality of the wrist can be restricted, accompanied by a loss of strength or sensory disturbances in the hand.

Diagnosis: How is a distal radius fracture diagnosed?

First of all, the doctor asks how the accident happened and the symptoms (anamnesis). He then looks at the wrist and forearm to identify external changes such as swelling or misalignment. In addition, the doctor checks whether there are circulatory disorders, disorders in mobility or feeling (sensitivity). He scans the affected region and looks for other accompanying injuries. To confirm the diagnosis, an X-ray of the forearm and wrist with the carpal bone is taken. In this a broken bone is almost always visible. In addition, a computed tomography (CT) or magnetic resonance examination (MRT) may be necessary, for example in the case of suspected accompanying injuries or complicated fractures involving the joint surface. Arthroscopy is only used for special injuries and is not part of the standard diagnosis.

Therapy: How is a distal radius fracture treated?

In principle, a distinction is made between treatment without surgery (conservative) and surgical treatment. Which form of therapy is used depends, among other things, on the type of fracture and the accompanying injuries. Concomitant injuries can be torn ligaments, for example. Age, general condition and wishes of the patient as well as the bone structure itself play a role in the choice of the appropriate therapy. The aim is to regain the correct position of the bones so that function and strength are fully restored.

  • Conservative care

This procedure is mainly used for "simple" fractures, either without joint involvement or without significant displacement of the fracture ends against each other. If the ends of the fracture are slightly offset, they can be moved back into the correct position in relation to one another (repositioning). To make this possible, the patient is given appropriate medication that suppresses the pain. This can be done either in the form of syringes and a so-called fracture gap anesthesia, but also by means of a short anesthetic. Which method is used depends on the type of fracture, as there are different methods of suitable "re-establishment" of the fracture ends. This is followed by immobilization using a plaster splint or a plastic plaster (cast splint) for four to six weeks, depending on the age of the patient and the bone substance. During this time, follow-up exams and x-rays will be done to see if the bone is healing in the correct position.

Even if, for example, an operation is not possible due to a poor general condition or the patient refuses the operation, conservative therapy can be used.

  • Operative care

Surgical treatment is necessary for the following fractures:

- the fracture ends differ significantly from each other (dislocation)

- Open fractures (the skin is also injured, so there is a connection to the outside world)

- Debris fractures (multi-fragment fractures)

- Existing accompanying injuries (injured vessels, nerves or carpal bones)

Depending on the type of fracture, different methods are used to stabilize the fracture (osteosynthesis method). Screws, wires (so-called Kirschner wires), external fixators (an external holding device for comminuted fractures) or metal plates can be used. Most often, a distal radius fracture is stabilized by a metal plate (angle-stable plate fixation). This is usually followed by a plaster splint. The surgeon decides on the duration of the plaster splint, depending on the type of fracture, the procedure used, the accompanying injuries and the bone substance. Whether another operation is necessary to remove the materials depends on various factors, including the type of osteosynthesis material and the general condition and age of the patient.

Prognosis: What are the chances of recovery?

The prognosis is favorable for most radius fractures. Usually the arm becomes functional again. However, consequential damage such as osteoarthritis can occur and depend on the extent of the injury to the wrist.

Dr. Peter Gutsfeld

© Garmisch-Partenkirchen Clinic

Our advisory expert:

Dr. Peter Gutsfeld, specialist in surgery, special trauma surgery, orthopedics and trauma surgery, worked as a senior physician in trauma surgery and sports orthopedics at the Garmisch-Partenkirchen Clinic until the end of 2016. In 2017, Dr. Gutsfeld to the Ohlstadtklinik of the German Pension Insurance North Bavaria.

Swell:

  • Professional Association of German Surgeons e.V, Die Radiusfraktur, C. Müller, April 2017. Online: https://www.bdc.de/die-radiusfraktur/ (accessed on May 14, 2019)
  • German Society for Trauma Surgery, Distal Radius Fracture (= spoke fracture near the wrist). Online: https://www.dgu-online.de/patienten/haeufige-diagnosen/senioren/distale-radiusfraktur.html (accessed on May 14, 2019)

Important NOTE:
This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions.

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