What is the importance of distal radius (wrist) fractures?
Wrist fractures account for approximately one-sixth, or 17 percent, of all fractures treated in an emergency room. While they occur more commonly in women, incidence increases in both men and women with advancing age, and more frequently result from a fall from level ground than higher-energy trauma. Postmenopausal osteoporosis for women has been regarded as a critical risk factor. For all seniors, fragility fractures include primarily vertebra fractures, hip fractures and wrist fractures. In a younger population, higher-energy trauma more commonly leads to distal radius fractures.
Wrist injuries can lead to many different diagnoses. A fall on the outstretched wrist can lead to dislocations between the wrist and the forearm. These can include many types of fractures of the distal radius and ulna, and fractures within the smaller bones of the wrist, as well as various ligament injuries and sprains. It is important to determine an accurate diagnosis.
Distal radius fractures, in particular, may be associated with a dislocation in the wrist joint, a fracture of the joint surface known as an articular fracture and an injury or fracture into the joint between the distal radius and ulna, known as the distal radioulnar joint. There are various treatment options based on the type of fracture and/or dislocation.
The goal of treatment is to restore hand, wrist and forearm function, and to limit pain and stiffness. Age and osteoporosis do not necessarily determine treatment. Treatment should be dependent on a person’s functional status and can range from cast treatment to bracing to surgery.
Cast treatment can lead to pain and discomfort, finger and forearm stiffness and tendon ruptures. Many patients complain of feeling “claustrophobic” because a cast can’t be removed.
Braces and splints offer newer types that allow patients to remain active without sacrificing fracture healing.
Surgical treatment has seen many advances recently with improved internal fixation, bone graft substitutes and lower-risk anesthetic options including localized-anesthetic-only procedures. Surgery is usually followed by use of a splint without the need for a cast and can enable progression to earlier range of motion of the wrist, hand and forearm.
What about a wrist fracture that didn’t heal properly?
Malunion of a distal radius fracture is a fracture that has healed in a nonanatomic alignment. This can lead to chronic wrist pain, finger and wrist stiffness, loss of range of motion of the wrist and forearm and problems at the distal radioulnar joint, such as ulnar impaction. The goal is to restore the wrist to anatomic or near-anatomic alignment to prevent complications that may occur after the fracture has healed. If the alignment is not properly restored, the wrist may develop different types of instability patterns, arthritis and incongruity between the radius and ulna, which leads to pain on the ulnar side of the wrist.
The proper treatment of distal radius fractures should be discussed in detail with each patient and, if properly treated, can lead to improved function of the wrist, hand and forearm.