Updated: 11/30/2019

Distal Radius Fracture

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Snapshot
  • A 72-year-old woman trips and falls on her outstretched right hand. She experiences immediate pain and swelling over her right wrist. On exam, she has a dinner-fork deformity of the wrist and exquisite pain with passive motion. A radiograph is shown, which reveals a dorsally angulated distal radius fracture. 
Introduction
  • Clinical definition
    • forearm fracture of the distal end of the radius
      • considered 1 of 3 common "fragility fractures" associated with osteoporosis
        • other 2 are vertebral compression fractures and femoral neck fractures
      • "Colles fractures" refer to dorsally angulated extra-articular distal radius fractures
  • Epidemiology
    • incidence
      • most common forearm fracture
    • demographics
      • bimodal distribution
        • younger patients
          • high energy injuries
          • more likely to be male
          • account for up to 25% of pediatric fractures
        • elderly patients
          • low energy injuries
          • more likely to be female
          • account for up to 20% of adult fractures
    • risk factors
      • osteoporosis
      • other fragility fractures (vertebral compression fractures and femoral neck fractures) are predictive of subsequent fractures
  • Etiology
    • fall on outstretched hand
  • Pathoanatomy
    • normal anatomy
      • radius and ulna are two bones of the forearm
      • radius widens in the distal forearm while the ulna narrows
      • distally, the radius articulates with 3 bones
        • ulna (distal radioulnar joint)
        • scaphoid (radioscaphoid joint)
        • lunate (radiolunate joint)
    • fracture location
      • most fractures occur at distal radial metaphysis can be
        • extra-articular or intra-articular
        • dorsally or volarly angulated
        • dorsally or volarly displaced
  • Associated conditions
    • distal radioulnar joint (DRUJ) injury
    • radial styloid fracture
    • ligamentous injuries
      • triangular fibrocartilage complex (TFCC) injury
      • scapholunate ligament injury
  • Prognosis
    • favorable
      • well-aligned anatomic reduction
    • negative
      • associated neurovascular injuries
      • fracture shortening on pre-reduction radiographs
      • osteoporotic bone
      • old age
Presentation
  • Symptoms
    • severe wrist pain
      • worse with passive motion
  • Physical exam
    • swelling
    • ecchymosis
    • tenderness to palpation
    • limited range of motion
    • deformity corresponding to fracture angulation and displacement
    • compartment syndrome should be carefully ruled out in forearm fractures
Imaging
  • Radiography 
    • indications
      • always indicated if fracture is suspected
    • findings
      • fracture fragment through distal radial metaphysis
      • eponymous fractures
        • Colles fracture
          • dorsally angulated extraarticular distal radius fracture
        • Smith fracture
          • volarly angulated extraarticular distal radius fracture
        • Barton fracture
          • intra-articular fracture involving volar or dorsal lip of distal radius with an associated fracture dislocation of the radiocarpal joint
  • Computerized tomography (CT) scan 
    • indications
      • suspicion for intra-articular fracture
      • highly comminuted fractures to better discern fracture pattern
    • findings
      • can better demonstrate extent of intra-articular involvement and individual fracture fragments
  • Magnetic resonance imaging (MRI) scan 
    • indication
      • suspicion for associated ligamentous injuries
    • findings
      • TFCC tear
      • scapholunate ligament tear
Differential
  • Scaphoid fracture
    • tenderness will be localized to the thenar snuffbox more than the distal radius
    • radiographs will be normal or show a fracture line in the scaphoid
  • DRUJ dislocation
    • radiographs will demonstrate radioulnar instability
Treatment
  • Nonoperative
    • closed reduction followed by immobilization post
      • indication
        • most non-comminuted extra-articular distal radius fractures
  • Operative
    • open reduction and internal fixation 
      • indications
        • unstable fractures
          • intra-articular fractures
          • severely displaced fractures post-reduction
          • comminuted fractures
Complications
  • Median nerve neuropathy
    • acute carpal tunnel syndrome
  • Extensor pollicis longus rupture
  • Malunion or nonunion
 

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