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Fractures

Wrist Fractures: Distal Radius Fracture Guide

The most common fracture in adults. Comprehensive information on Colles', Smith's, Barton's and other distal radius fractures.

Understanding Wrist Fractures

Distal radius fractures are the most common fractures in adults, accounting for approximately 15% of all fractures seen in emergency departments. They occur at the end of the radius bone, within 3cm of the wrist joint.

Epidemiology: Bimodal distribution - young adults (high-energy trauma) and elderly patients (low-energy falls, osteoporosis). Women are affected 4 times more than men in the older population due to osteoporosis.

Mechanism: Most commonly caused by a fall onto an outstretched hand (FOOSH). The position of the wrist at impact determines the fracture pattern - extended wrist causes Colles' type, flexed wrist causes Smith's type.

Fracture Types

Colles' Fracture

Most common pattern. Dorsal displacement and angulation. "Dinner fork" deformity. Occurs from fall onto extended wrist.

Smith's Fracture

"Reverse Colles'". Volar displacement. Occurs from fall onto flexed wrist or direct blow to dorsum of wrist.

Barton's Fracture

Intra-articular fracture-dislocation. Dorsal or volar rim fracture with carpal subluxation. Usually requires surgery.

Die-Punch Fracture

Depression of lunate facet. Caused by axial load. Intra-articular injury requiring anatomic reduction.

AO/OTA Classification: The standardized classification system divides fractures into: Type A (extra-articular), Type B (partial articular), Type C (complete articular). Higher types indicate more severe fractures with worse prognosis.

Signs & Symptoms

Clinical Presentation

• Pain: Immediate severe pain at the wrist

• Swelling: Rapid swelling of the wrist

• Deformity: Visible deformity - "dinner fork" (Colles') or "garden spade" (Smith's)

• Tenderness: Point tenderness over distal radius

• Loss of function: Unable to grip or move wrist

• Bruising: Develops over hours to days

Important: Always assess for associated injuries: median nerve compression (carpal tunnel symptoms), DRUJ injury, scaphoid fracture, carpal ligament injuries. Check finger movement and sensation before and after treatment.

Diagnosis & Assessment

X-rays: PA, lateral, and oblique views. Assess:

  • Radial height: Normal 11-12mm (shortening indicates instability)
  • Radial inclination: Normal 22-23° (PA view)
  • Volar tilt: Normal 11-12° (lateral view) - dorsal tilt indicates displacement
  • Articular step-off: >2mm associated with poor outcomes

CT Scan: For intra-articular fractures to assess articular surface, plan surgery, and evaluate complex fracture patterns.

DRUJ Assessment: Check distal radioulnar joint stability clinically and radiographically. Ulnar styloid fractures may indicate DRUJ injury.

Treatment Options

Acceptable Alignment (Non-operative): Radial shortening <3mm, radial inclination loss <5°, dorsal tilt <10-15°, articular step-off <2mm. These parameters guide treatment decisions.

Conservative Treatment - Cast Immobilization

Indications:

  • Stable, non-displaced fractures
  • Fractures meeting acceptable alignment criteria
  • Low-demand elderly patients

Protocol:

  • Closed reduction under local/regional anesthesia
  • Below-elbow cast or splint
  • Duration: 6 weeks typically
  • Weekly X-rays for first 2-3 weeks to check for displacement
Surgical Treatment

Indications:

  • Intra-articular step-off >2mm
  • Radial shortening >3mm
  • Dorsal tilt >10-15°
  • Unstable fracture pattern
  • Loss of reduction in cast
  • Associated injuries (carpal injury, DRUJ disruption)

Surgical Options:

Volar Locking Plate: Most common. Metal plate on volar (palm) side of radius. Early motion allowed. Excellent stability.

External Fixation: Frame outside skin holding reduction. Used for highly comminuted fractures or open fractures.

K-wires: Percutaneous pins. Good for simple fractures, lower cost. Require cast protection.

Fragment-specific Fixation: Multiple small plates for complex fractures.

Recovery Timeline

0-6 weeks
Bone Healing
Cast treatment or post-surgical immobilization. Finger exercises essential. X-ray monitoring.
6-12 weeks
Rehabilitation
Cast removed. Wrist physiotherapy begins. Progressive strengthening. Return to light activities.
3-6 months
Full Recovery
Full strength returns. Sport/heavy work permitted. Some patients take up to 1 year for maximum recovery.

Evidence & References

  • • Nellans KW, et al. The epidemiology of distal radius fractures. Hand Clin. 2012
  • • Lichtman DM, et al. Treatment of distal radius fractures. JAAOS. 2010
  • • DRAFFT Trial: Costa ML, et al. Volar locking plate versus cast for distal radius fractures (DRAFFT). JAMA. 2014
  • • Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg Am. 2002

Last Updated: January 2025 | Content reviewed by Dr. Deepthi Nandan Reddy, FRCS (Ortho)

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