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.
- Total incidence: 2.5% of all emergency department (ED) visits 
Bimodal peak incidence 
- 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
Epidemiological data refers to the US, unless otherwise specified.
- Mechanism of injury 
- See “.”
- Result of a fall on an extended wrist
- The distal fragment is usually radially angulated and dorsally displaced.
- Intraarticular extension is possible.
- Smith fracture
- Barton fracture
- Reverse Barton fracture
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 
Clinical evaluation 
- Skin exam: Evaluate for laceration, tearing, and tenting.
X-ray: anterior-posterior, lateral, and oblique views of the wrist (including the carpal bones)
- Assess angulation, rotational deformity, shortening, joint alignment, and comminution.
- Radial inclination: Inclination ≥ 10–15° indicates acceptable fracture reduction. 
- Volar inclination: Inclination > 20° indicates a potentially unstable fracture. 
- See “.”
- CT wrist: may be required for preoperative planning 
See also “.”
- Ligamentous injury
- Triangular fibrocartilage complex sprain
- : associated with
- Ulnar styloid fracture
- Carpal bone fractures, e.g., ,lunate fracture
- Carpal bone subluxation and/or dislocation
- See also “Overview of radius and ulna fractures.”
The differential diagnoses listed here are not exhaustive.
|Initial management of distal radius fractures by fracture type |
|Nonoperative management||Indications for an emergent orthopedic consult|
|Barton fracture|| || |
|Reverse Barton fracture|
|Hutchinson fracture|| |
|Die-punch fracture|| || |
Nonoperative management 
- Closed reduction while applying longitudinal traction through the fingers either manually or using a finger trap
- Initial immobilization in sugar tong splint
- Short arm cast when edema resolves
- Postreduction x-rays and serial exams to evaluate for subsequent displacement
- Cast removal after 6 weeks
- See also “ .”
The radius should be realigned to its normal position after fracture reduction.
Operative management 
Operative fixation in patients ≥ 65 years of age does not improve long-term functional outcomes. 
- Open, significantly displaced, intraarticular, and/or unstable fractures
- Neurovascular injury
- Any of the following post-reduction radiographic signs of instability:
- > 3 mm radial shortening
- ≥ 10° dorsal tilt
- Intraarticular step-off > 2 mm
- Concurrent ulnar fracture
All procedures require postoperative immobilization of the forearm and wrist.
- : Fixed-angle volar plates are used for displaced, unstable, and/or involve osteoporotic bone.
- : typically limited to patients with minimal fixationfracture comminution and healthy bone
- External fixation: typically used in patients with severe soft tissue injury and/or polytrauma