- Clinical science
Distal radius fractures are a common fracture of the arm, with a bimodal peak incidence between the second and third decade and individuals above 65 years of age. The mechanism of injury may be due to low-energy falls, especially in women with osteoporosis, or high-energy trauma that occurs during sports or motor vehicle accidents. Clinical features include tender, soft tissue swelling with decreased range of motion at the wrist joint. The diagnosis is confirmed by x-ray. While closed reduction may be considered as conservative therapy, more severe fractures (e.g., unstable, intraarticular, or open fractures) require surgical therapy.
- Bimodal peak incidence
- 10–30 years of age; typically due to high-energy trauma in males
- > 65 years of age; typically due to low-energy trauma in women with osteoporosis
Epidemiological data refers to the US, unless otherwise specified.
- Colles fracture: extension fracture; the distal fragment is usually radially and dorsally displaced
- Smith fracture: flexion fracture; the distal fragment is displaced radially and ventrally
- Barton fracture: fracture dislocation; palmar Barton fracture involves avulsion and volar displacement of the radiocarpal segment; dorsal Barton fracture a radial avulsion and dorsal displacement of the radiocarpal segment
- Hutchinson fracture: avulsion fracture of the radial styloid
- Look for .
- Check for neurovascular deficits.
X-ray: anterior-posterior, lateral, and oblique view of the wrist (including the carpal bones)
- See .
- Radial inclination: In the posteroanterior view of a normal wrist joint, a line that is drawn tangential to the radial styloid, connecting the ends of the distal radius, makes a 30º angle with a line drawn perpendicular to the long axis of the radius (see diagram below).
- Volar inclination: In the lateral view of a normal wrist joint, a line that is drawn parallel to the articular surface of the distal radius makes a 10° angle with a line drawn perpendicular to the long axis of the radius.
The differential diagnoses listed here are not exhaustive.
- Closed reduction while applying longitudinal traction through the fingers
- Dorsal forearm splint/casting and post-reduction x-rays
- Cast removal after 6 weeks
- Open, significantly displaced, intraarticular, and/or unstable fractures
- Neurovascular damage
- Open reduction and internal fixation
- K-wire fixation
- Internal fixation with fixed-angle plates
- External fixation
- Postoperative immobilization of the forearm and in a dorsal forearm splint
- See .
We list the most important complications. The selection is not exhaustive.