What are Distal radius fractures?
A distal radius fracture is a break in the radius bone near the wrist, which is the most commonly fractured bone in the forearm. It typically occurs just above the wrist joint and can vary from a simple, non-displaced crack to a more complex fracture with bone displacement or joint involvement. This injury most often results from a fall onto an outstretched hand, where the force of impact is transmitted through the wrist and into the distal radius. It is particularly common in older adults with osteoporosis, where even low-energy falls can cause a fracture, but it can also occur in younger individuals following high-energy trauma such as sports injuries or accidents. Symptoms usually include sudden wrist pain, swelling, bruising, reduced movement, and sometimes visible deformity if the bone is significantly displaced. In more severe cases, there may also be numbness or tingling if nearby nerves are affected.
Causes
A distal radius fracture is most commonly caused by a fall onto an outstretched hand, where the force of impact is transmitted through the wrist to the radius bone near the joint. In older adults, even a simple low-energy fall from standing height can be enough to cause the bone to break due to reduced bone strength. In younger individuals, distal radius fractures are more often the result of high-energy trauma such as sports injuries, cycling accidents, or motor vehicle collisions. Underlying conditions that weaken bone, such as osteoporosis or other metabolic bone diseases, significantly increase the risk of fracture.
Symptoms
Sudden wrist pain: Sharp pain occurs immediately after the injury and worsens with any attempt to move or use the wrist.
Swelling around the wrist: Rapid swelling develops due to soft tissue injury and bleeding around the fracture site.
Bruising (discolouration): The skin may become blue or purple as blood leaks into surrounding tissues.
Visible deformity (“dinner fork” deformity): In displaced fractures, the wrist may appear bent or misaligned due to the shifted bone position.
Reduced wrist movement: Difficulty or inability to move the wrist because of pain, swelling, and structural instability.
Tenderness over the distal radius: Pressing on the wrist causes significant pain at the fracture site.
Weak grip strength: Holding or lifting objects becomes difficult due to pain and loss of normal wrist mechanics.
Numbness or tingling in the hand: Swelling may compress nearby nerves, sometimes leading to symptoms such as pins and needles, especially in the fingers.
Diagnosis
Your surgeon will first taking a detailed history of the injury. A physical examination is then performed to assess for swelling, tenderness over the distal radius, deformity, reduced range of motion, and any signs of neurovascular compromise, including numbness or reduced blood flow to the hand.
Imaging
To confirm the diagnosis, imaging is essential, with plain X-rays of the wrist taken in multiple views (usually anteroposterior and lateral) as the first-line investigation to identify the fracture pattern, degree of displacement, and joint involvement. In more complex fractures, particularly those extending into the joint surface or involving multiple fragments, a CT scan may be used to provide more detailed three-dimensional information to assist with surgical planning. MRI is rarely required but may be used if there is suspicion of associated soft tissue or ligament injury.
Treatment
Conservative (Non-operative)
Conservative management of distal radius fractures is appropriate for stable, non-displaced, or minimally displaced fractures, and aims to allow the bone to heal in good alignment while restoring function. Initial treatment usually involves reduction if needed to realign the bone, followed by immobilisation in a plaster cast or splint, typically extending from below the elbow to the hand to restrict wrist movement. The arm is often supported in a sling for comfort, and pain is managed with simple analgesia. Patients are encouraged to move their fingers, elbow, and shoulder early to prevent stiffness while the wrist remains immobilised. Regular follow-up X-rays are important during the first few weeks to ensure the fracture position is maintained. Once sufficient healing has occurred, usually after several weeks, the cast is removed and physiotherapy is started to restore wrist range of motion, strength, and function. Recovery may take several months, especially in older patients or more complex fractures.
Surgical treatment
Surgical management of distal radius fractures is indicated when the fracture is unstable, significantly displaced, involves the joint surface, or cannot be maintained in acceptable alignment with a cast alone. The most common surgical option is open reduction and internal fixation (ORIF) using a volar locking plate and screws, which allows accurate realignment of the bone and stable fixation to enable early movement of the wrist and hand. In some cases, particularly with certain fracture patterns, percutaneous pinning (K-wire fixation) may be used to stabilise the fracture with wires inserted through the skin. Another option is external fixation, where a frame outside the body holds the bone in position, sometimes used in more severe or open fractures. In complex cases involving multiple fragments or significant joint damage, a combination of these techniques may be required. After surgery, rehabilitation with physiotherapy is essential to restore wrist motion, strength, and function while protecting the repair during bone healing.
Recovery
When can I return to daily and leisure activities?
Your ability to start these will be dependent on the range of movement and strength that you have in your wrist and forearm following your surgery.
Please discuss activities in which you may be interested with your therapist or surgeon. Start with short sessions, involving little effort and gradually increase.
General examples are :
- Driving – 6 weeks – once out of the splint and have full control of the vehicle
- Light lifting – 6 weeks, avoid heaving lifting for 3 months until we have confirmation via Xray that the fracture has healed.
- Cycling – 4 – 6 weeks on road, after wound healing on stationery bike
- Jogging – is possible in a splint after wound has healed until 6 weeks (avoid if swelling increases)
- Swimming – gentle breast-stroke 4 weeks, freestyle variable
- Light sports/racquet sports using non-operated arm – 6 weeks
- Racquet sports / Golf using operated arm – 10 – 12 weeks
- Contact or collision sports which includes horse riding, soccer, martial arts, football and rock climbing – 4 to 6 months