DISTAL RADIUS Fractures
A wrist fracture, or a distal radius fracture, most commonly occurs at the distal end of the radius bone. This frequently results from falling onto the hand.
In adults, wrist fractures are more likely to occur when bone quality is poor, such as in individuals with osteoporosis. The injury can result in pain, swelling, bruising, and sometimes a noticeable deformity. Occasionally, the swelling or deformity can produce some numbness or tingling in the fingers.
The degree of “displacement”, or shift of the fracture pieces, helps to decide the best course of treatment.
Non-surgical treatment
Non-displaced fractures can usually be treated in a cast or splint until the bone heals itself. Displaced fractures may result in impaired motion, prolonged pain, or arthritis. In these cases, re-aligning the fracture by setting the bone may be beneficial.
Wrist fracture being immobilized with a custom-molded splint
Surgery
Occasionally, surgical treatment of the fracture may provide the best outcome, especially when the fracture extends into the wrist joint or shifts the alignment of the radius bone.
A metal plate and screws are used to hold the pieces of bone in place while the fragments mend themselves and heal together.
Surgery can also speed up the recovery. Typically, patients are placed in a removable wrist splint ~2 weeks after surgery and range of motion exercises of the wrist are started.
Around ~6 weeks after surgery, the fracture has typically healed, patients wean from the splint, and strengthening exercises are started.
Throughout treatment, it is important to continue to move the fingers to prevent stiffness and minimize swelling.
X-ray of a distal radius fracture after surgical treatment.
Example of metal plate and screws used to surgically fix a distal radius fracture.
Left: Lateral x-ray of a distal radius fracture treated with a metal plate and screws to restore alignment.
Right: Bone model demonstrating how metal plate can help restore normal tilt of the joint surface.
To read more about wrist fractures, click here.
“Had one of the worst breaks with my wrist and Dr. Schreiber took great care of it. He told me from the beginning that it was a bad break but he would get me back to as normal as possible and he did. Would recommend him for any hand and wrist injuries.”
“Wrist surgery for 90 year old mother had an excellent outcome. Terrific “bedside manner” who explains things well. Shows sympathy/empathy and concern for the individual. Would recommend him highly.”
Osteoporosis
Osteoporosis is a medical condition where the body either loses too much bone tissue or does not make enough of it - resulting in bones that are brittle, fragile and more prone to fractures.
Individuals that have broken their wrist following a “low energy fall” may have decreased bone density – or osteoporosis. Falling while walking, or falling from a chair, would be considered a “low energy fall” and would not be expected to cause a broken wrist. “High energy” injuries, such as a car accident or falling from a bike or ladder, can cause fractures in even the highest quality bone.
Healthy bone (left), osteopenia (middle images), osteoporosis (right)
If a fracture occurs from a simple fall, you may have decreased bone density. The quality of your bone can be measured from a test called a bone density scan, or DEXA (Dual Energy X-ray Absorptiometry) scan. This test will determine if you have normal bone, osteopenia (slightly decreased bone density), or osteoporosis (greatly decreased bone density).
A DEXA scan is typically recommended for any female over the age of 65 or any individual who has suffered a low-energy “fragility fracture” – such as a broken wrist. Fortunately, if osteoporosis is diagnosed, it can be treated. Treating osteoporosis can greatly reduce your risk for subsequent fractures.
Dr. Schreiber has published multiple studies on developing new ways of diagnosing osteoporosis. Early diagnosis is crucial, as treating osteoporosis can significantly decrease your risk of future fractures.Click here to learn more about Dr. Schreiber's new method for diagnosing osteoporosis
Patients with distal radius fractures were found to have significantly decreased bone density in the wrist based on measurements made from CT scans. Click here to read more.
Patients with decreased bone density measured on CT scans of the wrist also have decreased bone density of their hip and spine. Osteoporosis related fractures of the hip and spine have serious health consequences. This study suggests that these measurements can help identify people who may benefit from treating their osteoporosis, which can minimize the risk of subsequent fractures. Click here to read more.
Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.