Fractures of the wrist (Radius and Ulna)
I had a fall onto the outstretched hand (FOOSH) and my wrist is hurting / I broke my distal radius The wrist is a complex joint comprised of 15 bones. These are radius and ulna of the forearm, eight carpal bones and five metacarpal bones. Depending on the energy of the incident you might have broken one or more bones that form part of your wrist - most commonly however it is the distal radius.
Regardless, you might find yourself in an emergency department, suffering from pain and information overload and need some guidance and care. Please feel free to get in touch (07 3394 4073) and we will endeavour to look after you acutely. Should you happen to be at Greenslopes Private Hospital Emergency Centre ask your treating doctor to notify us. This is a straight forward referral process and Dr Rhau is often able to see you on short notice.
What are the symptoms of distal radius fracture?
Following the trauma the wrist be painful to move and will develop swelling. Due to pain the usability and grip strength will also be diminished. In severe cases where the bone fragments have shifted (displaced), deviation of the wrist does occur.
Who gets a distal radius fracture?
Distal radius fractures (often called ‘wrist fractures’) are the most common fractures in the adult population. There is a proportional increase in distal radius fractures with age and these fractures are a key diagnostic signs for ‘osteoporosis’ (bone softening due to lack of mineralization). A fall onto the outstretched hand (FOOSH) can result in a distal radius fracture. Depending on the position of the wrist during the impact the direction of fracture is determined. If the wrist is fully extended at impact the radius can break and the fragment shifts to the back of the wrist. This deformity is called ‘Colles fracture’. If the wrist is flexed at impact the fragment can shift towards the front of the wrist and this deformity is called ‘Smith fracture’.
How is distal radius fracture diagnosed?
The clinical appearance of the wrist next to the patient’s history are early diagnostic signs. X-rays and CT scan will image the fracture very well and a CT scan 3D reconstruction of the fracture can assist in preoperative planning.
Treatment of distal radius fracture
The majority of distal radius fractures can be treated with immobilisation in a Plaster of Paris, fibreglass cast or thermoplastic custom brace. This applies for undisplaced fractures as well as for simple fractures which were reduced under sedation in an emergency department. X-rays should be repeated at one and two weeks to check for secondary fragment displacement. A total of four to six weeks immobilisation is sufficient to let the bone heal and hand therapy is required afterwards to regain motion and strength. Some fractures have multiple fragments and are therefore inherently unstable. Where a good position cannot be achieved with manipulation only or gaps and steps in the joint surface are present, surgery should be considered.
Surgery for distal radius fracture
If a distal radius fracture is too unstable to be managed with cast fixation or there are steps and gaps in the joint surface, open reduction and internal fixation (ORIF) is recommended. Most of theses surgeries are carried out as an overnight stay procedure. This is often more convenient and appropriate in order to manage pain and you will be discharged the following morning after an X-ray has been taken. During the surgery the individual fragments are realigned to produce an even joint surface and restore normal anatomy. The fracture is stabilised using a plate and screws. There are several possibilities ti access the distal radius and this is often and individual choice of the treating surgeon and also dependant on the fracture type. The surgical site will be injected with local anaesthetic to control postoperative pain and parts of your hand and fingers will be numb when you wake up in recovery. One big advantage of distal radius open reduction and internal fixation is that range of motion exercises can commence within a week after surgery in order to minimise wrist stiffness.
Preparing for surgery for distal radius fracture
In most cases we will refer you to a hand therapist to manage the swelling and fit a thermoplastic custom brace which will also be required after surgery. If required we will also arrange for a bulk billed pre-admission clinic at the hospital. This is run by a specialist anaesthetist who will gather information and request investigations that are required for safe anaesthesia. Our reception staff will advise of costs, hospital and admission details. Often these surgeries are carried out as emergency surgery and we will endeavour to provide as much information as possible prior to the procedure.
Recovery from surgery for distal radius fracture
After discharge from the hospital it is advised to keep the custom brace in place and elevate the wrist as much as possible until you see the hand therapist. You can use use the hand for light activities of daily living as long as it is protected but the brace. The hand therapist will change the first postoperative dressing and commence a series of wrist and finger exercises. Sutures are generally internal and dressings can be discontinued about ten days after the procedure. Over the course of four weeks exercises will increase in intensity and after that period the brace can be weaned off. This is also the point of time of a final x-ray and review appointment with your surgeon. During the following weeks normal motion and strength will improve and full recovery can be expected three to six months after surgery.