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Distal Radius Fractures

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Dr Jacqueline Tan

MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)

A distal radius fracture occurs when the radius, the larger of the two forearm bones, breaks near the wrist. These fractures commonly occur approximately an inch from the bone’s distal end and are one of the most frequent arm injuries. These fractures can vary in severity, ranging from minor breaks to complex fractures involving the wrist joint. This type of fracture can significantly impact wrist function, often requiring prompt diagnosis and treatment to restore mobility, strength, and alignment.

Symptoms of Distal Radius Fractures

Symptoms of a distal radius fracture typically develop immediately after the injury and may worsen over the first few hours. Common signs include:

  • Pain and Swelling: Severe pain near the wrist that worsens with movement, often accompanied by noticeable swelling shortly after the injury.
  • Deformity: The wrist may appear visibly crooked, bent, or misaligned after the fracture, depending on the severity of the injury.
  • Bruising: Discolouration around the wrist and hand may develop within hours or days, indicating underlying tissue damage.
  • Limited Mobility: Difficulty moving the wrist, fingers, or hand, combined with weakened grip strength, can make daily activities challenging.
  • Numbness or Tingling: Sensations in the fingers may be affected if nearby nerves are compressed or injured, sometimes leading to temporary or prolonged numbness.

Causes and Risk Factors

Distal radius fractures occur when a force exceeds the bone’s strength. Several factors contribute to these injuries:

  • Trauma or Falls: A fall onto an outstretched hand is the most common cause of distal radius fractures. High-impact trauma, such as car accidents or sports-related injuries, can also result in these fractures, often leading to more severe damage.
  • Osteoporosis: Weakened bones due to osteoporosis make individuals, especially older adults, more prone to fractures from relatively minor falls or impacts.
  • High-Impact Activities: Engaging in activities such as skiing, skateboarding, or contact sports increases the risk of distal radius fractures due to the higher likelihood of falls or collisions.
  • Occupational Risks: Jobs that involve frequent use of the hands or increased risk of falls, such as construction work or climbing, may predispose individuals to wrist injuries.

Types of Distal Radius Fractures

Distal radius fractures can vary in severity and complexity. The most common types include:

Open Fracture

The broken bone pierces the skin, creating an open wound. This type of fracture increases the risk of infection and requires immediate surgical intervention.

Comminuted Fracture

The bone shatters into three or more pieces, making alignment and stabilisation more challenging. These fractures often occur during high-impact injuries.

Intra-Articular Fracture

The break extends into the wrist joint, disrupting the joint surface and potentially impairing long-term wrist function if not properly treated.

Extra-Articular Fracture

The break occurs outside the wrist joint and does not affect the joint surface, often making it easier to treat.

Diagnosis of Distal Radius Fractures

Physical Examination

A thorough examination involves checking for swelling, deformity, and tenderness near the wrist. Your doctor may also test the range of motion, grip strength, and sensation in the fingers to assess nerve and blood vessel function.

Imaging Studies

X-rays are the primary imaging method for confirming the fracture and identifying its location and alignment. CT scans are used for complex fractures, providing detailed images of bone fragments and joint involvement. MRI is occasionally used to evaluate associated injuries, such as ligament tears or nerve compression.

Treatment Options

Treatment depends on the severity, type of fracture, and patient-specific factors such as age and activity level. The goal is to realign the bone and support proper healing to restore wrist function.

Non-Surgical Treatment

Immobilisation

Stable fractures with good alignment are treated with a cast or splint to keep the wrist immobilised during healing. A backslab (a partial cast that supports the wrist while allowing room for swelling) is often applied initially. Once swelling subsides, it is replaced with a full cast. Immobilisation typically lasts 4–6 weeks, with periodic X-rays to monitor the healing process.

Closed Reduction

For fractures with minor misalignment, the bone is manually realigned under anaesthesia. This is followed by immobilisation with a cast or splint to maintain proper alignment during the healing process.

Pain Management

Medications such as acetaminophen or non-steroidal anti-inflammatory drugs (e.g., ibuprofen and naproxen) are used to relieve pain and inflammation, particularly during the early stages of recovery when discomfort is most severe.

Physical Therapy

After immobilisation, physical therapy focuses on regaining wrist strength, flexibility, and range of motion. Exercises are tailored to individual recovery progress and are intended to prevent stiffness while improving functionality for daily activities.

Surgical Treatment

Open Reduction and Internal Fixation (ORIF)

ORIF involves surgically realigning the fractured bone and securing it with metal plates, screws, or pins. This method is used for fractures that are unstable, displaced, or involve the joint. It ensures proper alignment and stability during healing, reducing the risk of long-term complications.

External Fixation

External fixation uses metal rods or pins inserted into the bone and connected outside the skin to stabilise the fracture. It is typically used for severe fractures with significant swelling or soft tissue damage. This method minimises disruption to the injured area and provides temporary support while the bone heals.

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Prevention and Management

Preventing distal radius fractures involves steps to reduce fall risks and maintain strong bones. Ensuring safe environments by using handrails, removing tripping hazards, and wearing proper footwear can help prevent falls. Protective gear such as wrist guards can reduce injury risks during activities like cycling or skiing. Maintaining bone health through a calcium- and vitamin D-rich diet, weight-bearing exercises, and managing osteoporosis is necessary.

Frequently Asked Questions

How long does it take for a distal radius fracture to heal completely?

Bone healing usually takes 6–8 weeks, but full recovery, including restoring wrist strength, flexibility, and mobility, may take several months. The duration can vary based on the type of fracture and the treatment approach.

Can distal radius fractures cause nerve damage?

Yes, nearby nerves, such as the median nerve, can be compressed or injured by the fracture. This can cause symptoms like numbness, tingling, or weakness in the hand and fingers, and in some cases, may lead to lasting sensory or motor issues.

What are the signs of a misaligned bone after treatment?

Signs of misalignment include visible wrist deformity, persistent pain, or difficulty moving the wrist or hand. These symptoms may suggest the bone has not healed correctly and could require further assessment or correction.

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Dr Jacqueline Tan

MBBS (SG)

MRCS (Edin)

MMed (Surgery)

FAMS (Hand Surgery)

Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.

  • Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
  • Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
  • Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
  • Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.

Widely Published
In hand surgery

Active In
Academic Teaching

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    Mt Elizabeth Novena Hospital

    38 Irrawaddy Road #07-42
    Singapore 329563

    Weekdays: 8:30am – 5:30pm
    Saturdays: 8:30am – 12:30pm
    Sundays & Public Holidays: Closed

    +65 9230 9554