Distal Radius Fracture Treatment

A distal radius fracture is what most people mean when they say they broke their wrist, and it is the most common fracture in the human body. It occurs across every age group and for two quite different reasons: a young adult falls hard from a bike or a snowboard, or an older adult with thinner bone falls from standing height.

Steven Struhl, MD is board certified in orthopedic surgery and separately in sports medicine, serves as an attending surgeon at NYU Hospital for Joint Diseases and on the faculty of NYU School of Medicine, and has practiced in New York since 1991. The question that decides treatment here is not whether the wrist is broken, it is whether the alignment will hold.

How Distal Radius Fractures Happen

• Fall Onto an Outstretched Hand: the mechanism in the overwhelming majority.
• Osteoporosis: lowering the force required, which is why a fall from standing is enough in older adults.
• High Energy Trauma: motor vehicle collisions and falls from height, producing more comminuted patterns in younger patients.
• Sports: snowboarding, cycling, skating, and contact sport.

A distal radius fracture in an older adult after a low energy fall is a marker for osteoporosis, and it is worth investigating, since the wrist frequently breaks years before the hip does.

Fracture Patterns

• Colles Fracture: the fragment angled backward, producing the dinner fork deformity, and the most common pattern.
• Smith Fracture: the fragment angled forward, from a fall onto the back of the hand.
• Barton Fracture: the fracture extending into the joint with the wrist subluxing along with the fragment.
• Comminuted Fracture: broken into multiple pieces, which is harder to hold in position.
• Patterns Involving the Joint Surface: extending into the joint surface, where restoring that surface accurately matters most.

Symptoms

• Immediate Pain and Swelling: with an inability to use the hand.
• Visible Deformity: the wrist angled, in displaced fractures.
• Bruising: developing across the wrist and hand.
• Numbness in the Fingers: which raises the question of acute median nerve compression and needs prompt attention.
• Inability to Grip: or bear any weight through the hand.

Diagnosis and What Determines Treatment

Radiographs establish the fracture and the measurements that drive the decision. Three things are assessed: how far the fragment has tilted, how much length the radius has lost, and whether the joint surface has a step in it. CT is added for fractures involving the joint surface, since a step of even a couple of millimeters increases the risk of later arthritis meaningfully.

Non Surgical Treatment

Many distal radius fractures are treated in a cast, and the criteria are specific.

• Non Displaced Fractures: cast immobilization for approximately six weeks.
• Displaced Fractures That Reduce Well: manipulated back into position under local anesthesia and held in a cast.
• Repeat Radiographs: at one, two, and three weeks, because a proportion of reduced fractures slip during healing and that is when it happens.
• Lower Demand Patients: where some residual deformity is acceptable in exchange for avoiding surgery.
• Finger Motion Throughout: maintained daily, since stiff fingers are the complication that outlasts the fracture.

Distal Radius Fracture Surgery

Dr. Struhl operates on fractures that are unstable, that have lost position after reduction, and that involve the joint surface in a way that will not remodel.

• Volar Plate Fixation: a plate applied to the palm side of the radius, which is the most common technique and provides fixation stable enough for early motion.
• Percutaneous Pinning: wires holding the reduction, used in selected patterns and frequently combined with a cast.
• External Fixation: a frame spanning the wrist, used in severely comminuted fractures and in open injuries.
• Bone Graft or Substitute: filling a defect where the bone has been crushed.
• Wrist Arthroscopy: used alongside fixation to confirm the joint surface directly and to identify the ligament and TFCC injuries that accompany these fractures more often than radiographs suggest.

Recovery After a Broken Wrist

• Weeks One to Two: splint or cast, with finger, elbow, and shoulder motion started immediately.
• Weeks Two to Six: immobilization continued, or early wrist motion begun where fixation permits it, which is one of the advantages of plate fixation.
• Weeks Six to Twelve: cast discontinued, wrist motion restored with hand therapy.
• Months Three to Six: grip strength rebuilding, which lags motion considerably.
• Months Six to Twelve: the final result settling, with swelling and stiffness improving throughout the first year.

Carpal tunnel symptoms after a distal radius fracture are common and usually settle. Where numbness is severe and immediate, it is treated urgently rather than observed.

Schedule a Wrist Fracture Consultation in New York City

A broken wrist that was reduced and casted deserves the follow up radiographs, because a fracture that has slipped is straightforward to address in the first three weeks and considerably harder afterward. Dr. Struhl treats wrist fractures at his Manhattan and Westchester offices. Contact us to schedule an appointment.