• Clinical science

Distal radius fractures

Abstract

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.

Epidemiology

  • 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.

Etiology

Classification

See also fracture classification.

Clinical features

Diagnostics

  • Physical examination
  • X-ray: anterior-posterior, lateral, and oblique view of the wrist (including the carpal bones)

Differential diagnoses

See forearm fractures.

The differential diagnoses listed here are not exhaustive.

Treatment

  • Conservative therapy
    1. Closed reduction while applying longitudinal traction through the fingers
    2. Dorsal forearm splint/casting and post-reduction x-rays
    3. Cast removal after 6 weeks
  • Surgical therapy
    • Indications
      • Open, significantly displaced, intraarticular, and/or unstable fractures
      • Neurovascular damage
    • Procedures:
      • 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

The radius should be realigned to its normal position after fracture reduction!

Complications

We list the most important complications. The selection is not exhaustive.

last updated 06/05/2018
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