Distal radius fractures

Distal radius fractures are a common fracture of the arm, with a bimodal peak incidence between the second and third decade and individuals above 65 years of age. The mechanism of injury may be due to low-energy falls, especially in women with osteoporosis, or high-energy trauma that occurs during sports or motor vehicle accidents. Clinical features include tender, soft tissue swelling with decreased range of motion at the wrist joint. The diagnosis is confirmed by x-ray. While closed reduction may be considered as conservative therapy, more severe fractures (e.g., unstable, intraarticular, or open fractures) require surgical therapy.

• Overall incidence: 2.5% of all emergency department visits ^[1]
• Bimodal peak incidence ^[1]
  • 10–30 years of age; typically due to high-energy trauma in males
  • > 65 years of age; typically due to low-energy trauma in women with osteoporosis

Epidemiological data refers to the US, unless otherwise specified.

• Mechanism of injury ^[2]
  • Fall onto an outstretched hand
    • Dorsiflexed wrist (a typical protective action used to break one's fall) → extension fracture (Colles fracture)
    • Palmar-flexed wrist → flexion fracture (Smith fracture)
• Risk factors
  • Osteoporosis
  • See “Etiology of fractures.”

• Colles fracture
  • Extension fracture
  • The distal fragment is usually radially and dorsally displaced.
• Smith fracture
  • Flexion fracture
  • The distal fragment is radially and ventrally displaced.
• Barton fracture
  • Extension fracture
  • Involves radial avulsion and dorsal displacement of the radiocarpal segment
• Reverse barton fracture
  • Flexion fracture
  • Involves avulsion and volar displacement of the radiocarpal segment
• Hutchinson fracture: avulsion fracture of the radial styloid
• See “Fracture classification.”

• Pain, tenderness, and soft tissue swelling
• Reduced range of motion at the wrist joint
• Wrist deformities based on the type of fracture
  • Colles fracture: dorsally displaced and dorsally angulated fracture (bayonet or "dinner fork" deformity
  • Smith fracture: “garden spade” deformity
• See “Fracture signs.”

• Physical examination: peripheral perfusion, motor function, and sensation
• X-ray: anterior-posterior, lateral, and oblique view of the wrist (including the carpal bones)
  • See “Radiographic signs of a fracture.”

• Monteggia fracture
• Galeazzi fracture
• Scaphoid fracture

The differential diagnoses listed here are not exhaustive.

• Conservative therapy
  • Closed reduction while applying longitudinal traction through the fingers
  • Dorsal forearm splint/casting and post-reduction x-rays
  • Cast removal after 6 weeks
• Surgical therapy
  • Indications
    • Open, significantly displaced, intra-articular, and/or unstable fractures
    • Neurovascular damage
  • Postoperative immobilization of the forearm and in a dorsal forearm splint

The radius should be realigned to its normal position after fracture reduction.

See “Complications of fractures.”

We list the most important complications. The selection is not exhaustive.