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Wrist Fractures

Distal Radius Fractures (Broken Wrist)

The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end. A fracture of the distal radius occurs when the area of the radius near the wrist breaks. The descriptions fracture, break and hairline fracture or crack all describe a broken bone.  Distal radius fractures are very common. In fact, the radius is the most commonly broken bone in the arm. 

Types of Wrist fracture
One of the most common distal radius fractures is a Colles fracture, in which the broken fragment of the radius tilts upward. This fracture was first described in 1814 by an Irish surgeon and anatomist, Abraham Colles -- hence the name "Colles" fracture.

Other ways the distal radius can break include
Intra-articular fracture:   A fracture that extends into one of the wrist joints. ("Articular" means "joint.")

Extra-articular fracture:   A fracture that does not extend into the joint is called an extra-articular fracture.

Open fracture:   When a fractured bone breaks the skin, it is called an open fracture. These types of fractures require immediate medical attention because of an increased risk of infection.

Comminuted fracture:   When a bone is broken into more than two pieces, it is called a comminuted fracture.

It is important to classify the type of fracture, because some fractures are more difficult to treat than others. Some types will require different treatments and may be associated with a worse long term outcome.

Sometimes, the other bone of the forearm (the ulna) is also broken. This is called a distal ulna fracture.

How do Wrist Fractures occur?
The most common cause of a distal radius fracture is a fall onto an outstretched arm. This can be from standing height or, for example, off a chair. Other fractures are what we call “high energy”.  These may occur, for example, following a fall from a height (such as a ladder) or can occur at speed, for example, in motorcycle or mountain bicycle injuries. High energy fractures tend to be more severe, more often comminuted and intra-articular and associated with worse outcomes.

Osteoporosis, a disorder in which bones become very fragile and more likely to break, can make a relatively minor fall result in a broken wrist.  Many distal radius fractures in people older than 60 years of age are caused by a fall from a standing position. In this group of fractures it is important to assess whether osteoporosis is present or not.

Symptoms
A broken wrist usually causes immediate pain, tenderness, bruising, and swelling. In many cases, the wrist will look deformed or bent.

Diagnosis
This is usually made from the clinical history, (the account of events and symptoms from the patient)  clinical examination and X-rays.  Very occasionally X-rays may not show a fracture and special scans CT (computed tomography) or an MRI scan may be required. An MRI scan can also be useful if an associated ligament injury is suspected.

The initial assessment and X-rays are usually undertaken in the Accident and Emergency Department. At the same time a temporary plaster cast or splint will be applied. 

Treatment
The principles of treatment of fractures are to put the bones back in a “normal” position and hold them there until the fracture healed. This may be done with plaster of Paris, pins, plates and screws or special frames called external fixators. The choice as to which of these is most appropriate depends on many factors, such as the nature of the fracture, your age and activity level, and the surgeon's personal preferences.

If the position (alignment) of your bone is out of place and likely to limit the future use of your arm, it may be necessary to re-align or “manipulate” the broken bone fragments. This manipulation may be undertaken under a local, regional (arm numbed) or general (asleep) anaesthetic.   We call this “reduction of the fracture”.   If the fracture is going to be treated in plaster then this will be done without cutting the skin. If a plate is to be applied then the skin will be opened after  the manipulation  and an “open  reduction” performed followed by application of the plate and screws.