Distal radius fractures

Last updated: September 18, 2023

Summarytoggle arrow icon

Distal radius fracture is a common fracture of the arm, occurring most frequently in individuals 10–30 years of age and in those older than 65. The injury can be caused by low-energy trauma (common in women with osteoporosis) or high-energy trauma (e.g., sports injuries or motor vehicle accidents). Clinical features include wrist pain and tenderness, soft tissue swelling, visible deformity, and decreased range of motion at the wrist joint. Diagnosis is confirmed by x-ray. Nondisplaced stable fractures are typically managed with closed reduction and immobilization. Fractures that are open, unstable, comminuted, and/or accompanied by neurovascular injury are usually managed surgically.

Epidemiologytoggle arrow icon

  • Total incidence: 2.5% of all emergency department (ED) visits [1]
  • Bimodal peak incidence [1]
    • 10–30 years of age; most commonly due to high-energy trauma in male individuals
    • > 65 years of age; most commonly due to low-energy trauma in women with osteoporosis

Distal radius fractures are the second most common type of fracture in older adults presenting to the ED. [2]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Classificationtoggle arrow icon

This section lists common types of distal radial fractures and their mechanisms of injury. See “Fracture classification for general principles of fracture description. [4]

  • Colles fracture
    • Result of a fall on an extended wrist
    • The distal fragment is usually radially angulated and dorsally displaced.
    • Intraarticular extension is possible.
  • Smith fracture
    • Result of a fall onto a flexed wrist or direct injury to the back of the wrist
    • The distal fragment is volarly angulated and volarly displaced.
    • Intraarticular extension, neurovascular compromise, and/or instability are more likely than in Colles fractures.
  • Barton fracture
    • Result of a fall on an extended wrist.
    • Intraarticular fracture and dislocation
    • The radiocarpal segment is avulsed and dorsally displaced.
  • Reverse Barton fracture
    • Result of a fall on a flexed wrist
    • An intraarticular fracture and dislocation
    • The radiocarpal segment is avulsed and volarly displaced.
  • Hutchinson fracture (Chauffeur fracture)
    • Result of a direct blow to the radial portion of the wrist
    • The radial styloid is intraarticularly avulsed.
  • Die-punch fracture [5]
    • Result of an axial or transverse load through the lunate into the radius
    • Intraarticular depression fracture of the lunate fossa of the distal radius

Clinical featurestoggle arrow icon

Diagnosticstoggle arrow icon

Clinical evaluation [3]

Repeat the neurovascular exam after reduction and again after immobilization of the radial fracture. [4]

Imaging [3][6][7]

Obtain a second set of x-rays after reduction and immobilization of the fracture.

Differential diagnosestoggle arrow icon

See also “Types of distal radius fractures.”

The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

Overview [2][9][10]

Initial management of distal radius fractures by fracture type [4]
Nonoperative management Indications for an emergent orthopedic consult
Colles fracture
Smith fracture
Barton fracture
  • Rarely possible
  • Always consider emergent consult.
Reverse Barton fracture
Hutchinson fracture
Die-punch fracture
  • Not recommended [5][11]
  • Always consider emergent consult. [12]

Nonoperative management [2][3][4]

Nondisplaced and stable fractures are typically managed with closed reduction and immobilization. [2]

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

Operative management [2][3]

Indications [4][9]

Operative fixation in patients ≥ 65 years of age does not improve long-term functional outcomes. [9][10]

Common techniques

All procedures require postoperative immobilization of the forearm and wrist.

Complicationstoggle arrow icon

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

Referencestoggle arrow icon

  1. Nellans KW, Kowalski E, Chung KC. The Epidemiology of Distal Radius Fractures. Hand Clin. 2012; 28 (2): p.113-125.doi: 10.1016/j.hcl.2012.02.001 . | Open in Read by QxMD
  2. Mauck BM, Swigler CW. Evidence-Based Review of Distal Radius Fractures. Orthop Clin North Am. 2018; 49 (2): p.211-222.doi: 10.1016/j.ocl.2017.12.001 . | Open in Read by QxMD
  3. Levin LS, Rozell JC, Pulos N. Distal Radius Fractures in the Elderly. J Am Acad Orthop Surg. 2017; 25 (3): p.179-187.doi: 10.5435/jaaos-d-15-00676 . | Open in Read by QxMD
  4. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  5. Zhang J, Ji X ran, Peng Y, Li J tao, Zhang L hai, Tang P fu. New classification of lunate fossa fractures of the distal radius. J Orthop Surg. 2016; 11 (1).doi: 10.1186/s13018-016-0455-1 . | Open in Read by QxMD
  6. Ilyas AM, Jupiter JB. Distal Radius Fractures—Classification of Treatment and Indications for Surgery. Orthop Clin North Am. 2007; 38 (2): p.167-173.doi: 10.1016/j.ocl.2007.01.002 . | Open in Read by QxMD
  7. Perugia D, Guzzini M, Civitenga C, et al. Is it really necessary to restore radial anatomic parameters after distal radius fractures?. Injury. 2014; 45: p.S21-S26.doi: 10.1016/j.injury.2014.10.018 . | Open in Read by QxMD
  8. Hosseinzadeh P, Olson D, Eads R, Jaglowicz A, Goldfarb CA, Riley SA. Radiologic Evaluation of the Distal Radius Indices in Early And Late Childhood. Iowa Orthop J. 2018; 38: p.137-140.
  9. Management of Distal Radius Fractures Evidence-Based Clinical Practice Guideline. Updated: December 5, 2020. Accessed: December 30, 2022.
  10. Ochen Y, Peek J, van der Velde D, et al. Operative vs Nonoperative Treatment of Distal Radius Fractures in Adults. JAMA Netw Open. 2020; 3 (4): p.e203497.doi: 10.1001/jamanetworkopen.2020.3497 . | Open in Read by QxMD
  11. Zhang B, Hu P, Cheng X, et al. Volar, Splitting, and Collapsed Type of Die‐Punch Fracture Treated by Volar Locking Plate ( <scp>VLP</scp> ): <scp>A Retrospective</scp> Study. Orthop Surgery. 2020; 12 (3): p.869-877.doi: 10.1111/os.12695 . | Open in Read by QxMD
  12. Zhang X, Hu C, Yu K, et al. Volar locking plate (VLP) versus non-locking plate (NLP) in the treatment of die-punch fractures of the distal radius, an observational study. Int J Surgery. 2016; 34: p.142-147.doi: 10.1016/j.ijsu.2016.08.527 . | Open in Read by QxMD
  13. White BD, Nydick JA, Karsky D, Williams BD, Hess AV, Stone JD. Incidence and Clinical Outcomes of Tendon Rupture Following Distal Radius Fracture. J Hand Surg [Am]. 2012; 37 (10): p.2035-2040.doi: 10.1016/j.jhsa.2012.06.041 . | Open in Read by QxMD

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