DISTAL RADIUS FRACTURESIntroduction:
The radius is the larger of the two bones in the forearm. The other bone is called the ulna. (Figure 1) The part of the radius closest to the wrist is called the distal radius and the other side is called the distal ulna. Fractures of the distal radius are among the most common skeletal injuries and occur more frequently in the elderly and children. Women are more affected than men due to a higher incidence of osteoporosis. A wrist fracture occurs when someone falls on an outstretched hand. It can also happen while skiing, playing sports and during car accidents. The distal radius can fracture alone or along with the distal ulna.
A distal radius fracture usually results in pain, swelling, bruising of the affected limb and sometimes gross deformity with the wrist hanging in an odd position. (Figures 2, 3) It is important to seek medical attention at your nearest emergency room if you suspect that you broke your wrist. An emergency room doctor will examine you and obtain an x-ray. They can usually stabilize the wrist with a temporary splint, which holds the fracture in place, until you are able to come to our office.
There are several type of distal radius fractures. If the bone breaks the skin, that is considered an open fracture. If the bone is not displaced, it is called a hairline or non-displaced fracture. If the bone is out of place, it is a displaced fracture. If the bone breaks in more than 2 pieces, it is classified as a comminuted fracture. If the injury does not extend to the wrist joint it is considered an extra-articular fracture. If it involves the joint and the cartilage is affected, it is classified as an intra-articular fracture. (Figure 3-6)
The treatment for distal radius fractures varies according to the severity of the fracture. Treatment is individualized to the specific needs and expectations of our patients. Most fractures that are not displaced or mildly displaced are treated in a cast for 6-8 weeks. Some displaced fractures can also be treated non-surgically with a cast. It is applied a few days after the injury, once the swelling goes down. After the cast is removed, occupational / physical therapy is recommended. Sometimes, when a fracture is markedly displaced, a Hand Surgeon is called to the emergency room and an attempt at reducing the fracture to a better position is made before applying the splint. This is called a closed reduction.
Some fractures that are displaced and unstable do require surgical intervention. At Central Jersey Hand Surgery, we are the Wrist Fracture experts. We employ the latest innovative techniques available to achieve a reduction of the fracture and stability of the bone. This allows our patients a quicker return to their normal lives and activities. Our doctors are highly trained in treating distal radius fractures with surgery and have been involved, over the years, in training other surgeons how to fix these difficult comminuted fractures. Depending on the severity, the bone can be stabilized with pins only that are introduced through the skin without any incision. (Figure 7) In more involved cases, an external fixator can also be applied to obtain further stability. (Figure 8)
At Central Jersey Hand Surgery, we are also excited to offer our patients the latest techniques of wrist stabilization using a volar plate for fixation of the most severe fractures. This usually requires an incision on palmar aspect of the wrist and a plate and screws are applied on the inside to provide the stability. (Figure 9-15) The plate is very thin and flush against the bone. It does not usually need to be removed at a later date. The surgery is carried out as same day surgery, under general anesthesia. This can be performed in one of our three state of the art Ambulatory Surgery Centers located conveniently in proximity to our three offices. After a brief recovery period, the patient is sent home the same day.
The scar heals well and allows quicker mobilization of our patients. Once the stitches are removed, at the 2 week postoperative visit, a removable Velcro splint is utilized instead of a cast. Patients find it very convenient to be able to take normal showers after 2 weeks and not to have a cast on their arms for 6-8 weeks. They can start therapy as early as 2 weeks after surgery on their way to a quicker recovery with less stiffness and better anatomic reduction of the fracture. Most of our patients resume more physical activities such as skiing and sports 3 to 6 months after surgery.
It is important to note, though, that recovery varies with individual patients. An older person may take longer to heal. It can take 6 months to a year to fully recover and some residual stiffness, pain and loss of motion can be expected even with the best reduction and the simplest of fractures. Some injuries can also lead to post-traumatic arthritis, especially those fractures which damaged the articular surface and the cartilage of the wrist joint.
Figure 3: Pics of intraarticular, comminuted displaced fractures of the distal radius
Figure 4: Pics of intraarticular, comminuted displaced fractures of the distal radius
Figure 5: Pics of intraarticular, comminuted displaced fractures of the distal radius
Figure 6: Pics of intraarticular, comminuted displaced fractures of the distal radius