Wrist Fracture: Distal Radius
Why Does it Occur?
Distal radius fractures are usually caused by falling on an outstretched hand, although a direct blow to the distal radius can also cause a fracture. Patients will commonly ask if it is broken or merely fractured. Both terms actually mean the same thing, it's just that fracture is a more medical term. Each fracture of the distal radius is unique and depends on the direction and severity of the force as well as the patient's inherent bone properties.
Patient's most commonly experience pain on the thumb side of the wrist. Patients may also experience swelling, bruising, stiffness, or loss of movement. It is important to note that being able to open and close your fingers without much pain does not necessarily mean that you don't have a fracture.
Distal radius fractures are typically initially evaluated with x-ray. Sometimes the fracture cannot be adequately seen or the treatment cannot be adequately determined with just an x-ray. In these cases, additional radiologic studies such a Cat Scan (CT), MRI, or Bone Scan may be advised.
Whether or not a distal radius fracture requires a splint/cast, reduction/manipulation, or surgery depends on multiple factors. Considerations Dr. Steven Lee takes into account include the fracture displacement/angulation, shortening, joint involvement, whether it is associated with an open laceration, the age of the fracture, the age of the patient, how active the patient is, whether a reduction/manipulation maneuver has already been attempted, how quickly a patient needs to return to activities such as sports or work, etc. The parameters of what can be accepted non-surgically are typically more strict for the younger and more active patient.
If non-operative treatment has been chosen, the initial treatment is often a splint for up to 2 weeks. In children, a cast may be preferable if there is a concern of the child removing the splint. After two weeks, the choice of a cast versus some type of brace is typically made based on the stability of the fracture, patient compliance, and personal preference. While this is not typically popular with patients, the splint/brace/cast may have to go above the elbow if the fracture is deemed to be more of an unstable fracture pattern.
In general, non-displaced fractures are good and preferable because it usually means that no surgery or even manipulation of the bone is necessary. However, an interesting phenomenon can occur in less than 5% of patients with non-displaced distal radius fractures. Patients may sustain a tendon rupture to the tendon that extends the thumb (EPL tendon). If this happens, patients may feel a pop followed by the inability to extend their thumb into a hitchhiker's position. In the event that this happens, these patients will unfortunately require surgery to correct this problem by having a tendon transfer.
Multiple treatment options exist depending on the fracture pattern, age of the patient, and patient requirements. The basic surgical principles for fixing distal radius fractures believe it or not are not that different from carpentry, and therefore hardware that is used may seem like it comes from a hardware store, just medical grade! Because every fracture is unique, Dr. Steven Lee may utilize different techniques to best treat the fracture. While theoretically debatable, it is important that you have a skilled and experienced hand/upper extremity surgeon to handle your fracture. Even in those fractures that may not seem so complicated, you might be surprised how important that statement really is.
Dr. Steven Lee is not only one of the most experienced surgeons in New York City treating this diagnosis, but he routinely trains other surgeons on how to do them. If you are interested in watching a video on one of the ways this is done, please click here (warning: graphic content). Please note, though, that if you are squeamish, this video may not be for you!
Post Operative Care
Patients are encouraged to take 500 mg of Vitamin C daily, do everything possible to avoid additional trauma, stop smoking, abstain from dieting, and eat up to 20% more nutritional foods. We typically encourage opening and closing of the fingers, yet advise against any forced gripping or lifting anything heavier than the weight of a coffee cup. Also, taking the recommended daily allowance of Vitamin D and Calcium (even up to twice the recommended amount from the ADA) from food or supplemental sources may help to improve the healing potential of the fracture.
Healing of the injury can take anywhere from 4 to 12 weeks depending on the factors mentioned above. Following surgery, patients are usually placed into a splint. Patients are typically followed up 1-2 weeks after surgery for a wound check and to see if the sutures are ready to come out. At this point, either a cast or brace will typically be placed depending on fracture stability and patient needs. Physical therapy will often be instituted once the cast/brace is removed to restore range of motion, strength, and promote scar modulation. Physical Therapy may go on for up to 6-12 weeks and is an important part of the recovery process.
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.