Distal radius fracture

Quick Overview: What is a Distal Radius Fracture?

In a distal radius fracture, the radius breaks near the wrist. Older people are often affected by osteoporosis after a tripping fall, but sports and traffic accidents also occur among younger people. The fracture can occur outside the joint (extra-articular) or involving the articular surface (intra-articular) and can be associated with a violation of joint stability to the ulna (DRUJ).

• Typical mechanics: Fall onto the hand (FOOSH) - usually dorsal tipping (Colles fracture), more rarely volar tipping (Smith fracture).
• Key symptoms: pain, swelling, misalignment, restricted movement, pressure pain at the end of the spoke.
• Diagnostics: Clinical examination, X-ray in 2 planes; for complex fractures CT.
• Therapy: Immobilization and reduction for stable fractures; Surgery in cases of instability, joint difficulty, severe misalignment or impending malunion.
• Healing time: Bone healing approx. 6-8 weeks; Full resilience often only after 3-6 months.

Anatomy: Why is the end of the spoke so important?

The distal radius forms the distal radioulnar joint (DRUJ) with the distal ulna and, together with the carpal bones, forms the wrist. Ligaments and the TFCC complex (disco-ligamentous cartilage complex on the ulnar side) ensure joint stability. Nerves (especially the median nerve) and tendons of the finger extensors/flexors run close to the wrist. Even small steps in the joint surface can impair the sliding function and later lead to osteoarthritis.

• Joint axis and power transmission: The radius end carries the majority of the load.
• DRUJ and TFCC: Responsible for forearm rotation movements (pro-/supination).
• Neighborhood: median nerve (carpal tunnel), dorsal extensor tendons – relevant for complications.

Causes and risk factors

A typical trigger is falling onto an outstretched hand. For older people, low energy levels (osteoporosis) are often sufficient; for younger people, sports or traffic accidents often result in higher energy levels.

• Fall mechanism: Dorsal force → Colles fracture; Volar force → Smith fracture.
• High-speed trauma: Complex, multi-fragmentary, intra-articular fractures possible.
• Risk factors: osteoporosis, balance problems, vision problems, certain medications, previous falls.

Symptoms

• Acute pain in the wrist, dependent on stress and movement
• Swelling, hematoma, occasionally visible deformity (bayonet or fork deformity)
• Pressure pain over the end of the spoke, limited mobility
• Tingling/numbness in the thumb–middle finger area (indication of median nerve irritation)
• Weak grip, protective posture

Warning signs: when to clarify immediately?

• Open fracture (visible bone/wound over the fracture)
• Severe misalignment, persistent numbness/tingling or increasing pain
• Pale, cold hand or no pulse (circulatory disorder)
• Unbearable pain despite painkillers or severe tension pain (suspected compartment syndrome)

If you see these signs, please go to an emergency room immediately. Otherwise, see an orthopedist as soon as possible.

Diagnostics: This is how we proceed

The diagnosis combines anamnesis, clinical examination (blood flow, motor function, sensitivity, DRUJ stability) and imaging.

• X-ray pa and lateral (if necessary, oblique view): assessment of axes, shortening, joint involvement, debris zone.
• CT: For intra-articular fractures or unclear joint level/comminuted extent.
• MRI: Rarely initial; if ligament/TFCC injury or occult concomitant injuries are suspected.
• Sonography: assessment of tendon bearings; Soft tissue hematomas.
• Clinical tests: DRUJ instability, median nerve compression (carpal tunnel).

Classification and terms

• Eponyms: Colles (tilted dorsally), Smith (tilted volar), Barton (near the edge, intraarticular, dorsal or volar).
• AO classification: 23-A (extra-articular), 23-B (partially intra-articular), 23-C (completely intra-articular).
• Concomitant injuries: Ulnar styloid fracture, TFCC lesion, DRUJ instability, carpal ligament injuries.

Therapy: conservative or surgery?

The goal is a pain-free, functional restoration with a stable axis and the smoothest possible joint surface. The choice between conservative and surgical depends on stability, joint involvement, misalignment, biological age, demands and comorbidities.

Conservative treatment (for stable fractures)

• Indication (typical criteria): Dorsal inclination < 10°, shortening < 3 mm, joint step < 2 mm, no relevant comminuted zone, stable reduction over time.
• Procedure: Pain relief, if necessary closed reduction under analgesic sedation, immobilization in a forearm cast or removable cast/orthosis for 4–6 weeks.
• Checks: X-ray after 1 week (stability), if necessary after 2-3 weeks; clinical follow-up checks.
• Early function: Active finger/shoulder movement immediately; Wrist mobilization after medical clearance.
• Advantages: No surgical risks; Disadvantages: longer immobilization, risk of secondary dislocation.

Surgical treatment (if instability or joint involvement)

• Indications: Intra-articular step/gap > 2 mm, relevant axial deviation/shortening, secondary dislocation under plaster, open fracture, combined DRUJ instability, high functional demands.
• Goals: Anatomical reduction, stable fixation for early functional follow-up treatment.
• Timing: Usually within a few days of the trauma; Consider soft tissue swelling.

Surgical techniques at a glance

• Volar angle-stable plate osteosynthesis: standard for many extra- and intra-articular fractures; allows early mobilization.
• Percutaneous wire osteosynthesis (K-wires): For simple, stably reducible fractures.
• External Fixator/Bridging: For highly unstable, severely swollen or open fractures, often as a temporary solution.
• Volar/dorsally directed screws/miniplates: For marginal fractures (Barton) or dorsal fragments.
• Accompanying measures: TFCC treatment, temporary DRUJ immobilization; Ulnastyloid is treated selectively when functionally unstable.

Surgical risks are carefully considered: infection, nerve irritation (especially median nerve), tendon irritation/rupture (e.g. EPL), material problems, calcifications, painful scars. A differentiated indication and proper follow-up treatment reduce complications.

Follow-up treatment and rehabilitation

Structured follow-up treatment is crucial for function. The aim is to achieve a controlled, gradual increase in mobility and resilience.

• Pain and swelling management: elevation, cooling (short-term), appropriate analgesia as recommended by a doctor.
• Wound/cast check: Report pressure points, numbness, severe pain early.
• Movement: immediately actively move fingers, elbows, shoulders; Wrist depending on stability and procedure.
• Physio/occupational therapy: joint mobility, scar care, edema reduction, grip strength training.
• Stress: everyday stress according to consensus; Heavy loads at the earliest after bony healing (approx. 6-8 weeks), sporting stress gradually from 8-12 weeks.
• Control X-ray: Typically after 1-2 and 6 weeks; during surgery according to protocol.
• Ability to work: Desk work is often possible after 1-2 weeks (surgery) or 2-3 weeks (conservative); Manual work usually after 6-10 weeks – varies from person to person.

Possible complications

• Secondary dislocation, malunion (axis/length error), joint step → later arthrosis
• DRUJ instability, painful limitation of movement
• Nerve problems: median nerve compression/carpal tunnel syndrome
• Tendon irritation or rupture (e.g. long thumb extensor tendon, EPL)
• Complex regional pain syndrome (CRPS, Sudeck disease)
• Pseudarthrosis (rare), infection (especially after surgery)

Early detection and adjustment of treatment improve outcomes. If symptoms persist, we specifically examine the associated causes and take further steps.

Healing process and prognosis

• Bone healing: Usually 6-8 weeks; biological healing varies.
• Function: everyday functions often after 8-12 weeks; Strength and final mobility improve over months.
• Prognostic factors: age, osteoporosis, fracture type (intra-articular less favorable), accuracy of reduction, consistent follow-up treatment.

A fully resilient condition is not guaranteed and depends on many factors. Our goal is the best possible, everyday and work-oriented recovery.

First aid and self-help – what you can do yourself

• Immobilizing and elevating the wrist after the accident; Cool in short intervals.
• Painkillers only after consultation/on the basis of a doctor's recommendation.
• Remove jewelry (rings/watches) early before swelling increases.
• Avoid smoking – can affect bone healing.
• Exercises for fingers/shoulders according to instructions; Avoid overloads.

Prevention and osteoporosis check

After spoke fractures in old age, it is worth checking for osteoporosis. Fall prevention and bone health reduce the risk of further fractures.

• Vitamin D/calcium intake, bone-healthy diet
• Strength and balance training, check aids
• Drug osteoporosis therapy according to guidelines (after clarification)
• Safe living environment: carpet edges, lighting, handrails

Special cases: children, athletes, complex injuries

• Children/Adolescents: Frequently growth plate involvement; special healing tendency, but correct axis position is important.
• Athletes/manual professions: demand for early function; Stable fixation and closely guided rehabilitation are central.
• Complex comminuted/intra-articular fractures: If necessary, step-by-step approach with temporary stabilization, CT-supported planning.

Treatment in Hamburg: Serious, close to guidelines, individual

In our practice in Hamburg-Winterhude (Dorotheenstraße 48, 22301 Hamburg) we advise you on conservative and surgical options. We value careful indications, clear information and structured, everyday-oriented follow-up treatment. Regenerative procedures or infiltrations are only used if there are accompanying problems after careful consideration.