With the exception of the 18-34 age group, DR fractures are the most common fracture of the upper extremity. The overall incidence of annual DR fractures is increasing worldwide. In children, the highest incidence of distal radius fractures is at the age of 12-14 years in boys and 10-12 years in girls. The second peak for distal radius fractures occurs in adults over the age of 50. After hip fractures, they are the second most common fracture in older people. The highest incidence is found in women over the age of 65. Osteoporosis is a common risk factor here.
There are various treatment options, consisting of conservative treatment using plaster splints on the one hand and surgical interventions on the other.
Overview: What is a radial fracture?
The term “distal radius fracture” is a collective term for all fractures of the radius that occur near the wrist. This term alone can be misleading, as there are many types of distal radius fracture. They can all present differently, have different injury mechanisms and require different treatment.
Radius fracture: causes and risk factors
These fractures occur most frequently as a result of falls onto the outstretched hand. In older people, they are often the result of falls with low energy from a standing or sitting position. In children and adolescents, isolated distal radius fractures are more often the result of high-energy falls on the playground or during sporting events.
Symptoms: Pain and swelling
The most important signs of a radius fracture are
- Swelling that hurts
- Pressure pain
- Malposition of the wrist, shape changed
- Restricted movement of the wrist, associated with pain
- The sensitivity of the hand and fingers may be impaired.
- Skin and muscle injuries with an open fracture
However, the symptoms can also be less pronounced. This is the case, for example, if the radius is broken but the bone parts have not shifted and are still in their original position. Then there are usually no other signs apart from pressure pain and swelling.
Radius fracture: Diagnosis with us
If one or more of these symptoms appear after an external force, for example after a fall, it is likely that the spoke is broken. Please have this clarified by us as soon as possible.
A systematic approach in accident situations prevents radius fractures from being overlooked. The medical history focuses on the mechanism of the injury, the duration and the quality of the symptoms. During the targeted physical examination, gross deformities and the general appearance of the forearm are assessed. X-rays are the standard imaging modality for the diagnosis of distal radius fractures. During the X-ray examination, certain parameters are assessed, e.g. radial height, radial inclination, radial displacement, volar inclination, ulnar variance, the presence of concomitant ulnar styloid fracture and widening in the joint between the ulna and radius.
A computer tomography (CT) scan may be necessary if the X-ray images are not clear. CT imaging can also be useful in planning surgical fracture treatment, especially for intra-articular fractures.
Radius fracture: prevention, early detection, prognosis
The only way to avoid a broken spoke: Don’t fall, prevent falls as far as possible. This preventive measure is certainly difficult, if not impossible, to implement with children. Nevertheless, you should wear the appropriate protective clothing for sports where there is a risk of falling, such as hand protectors for inline skating.
For the second risk group, older people, it makes sense to detect osteoporosis as early as possible. Bone density measurement is a reliable way of detecting osteoporosis at an early stage. Fall prevention is also important – for example by practicing balance and sure-footedness.
Course, prognosis and complications of radius fracture
Simple distal radius fractures usually heal well and rarely have long-term complications. Complex fractures have variable prognoses that are multifactorial. Complex fractures have a higher rate of miscarriage and delayed bone healing, reduced joint function, neuropathic pain and post-traumatic osteoarthritis.
To prevent these complications, focused hand therapy is regularly used during the course of treatment.
Radius fracture: treatment primarily involves surgery
In the case of an uncomplicated radius fracture, conservative treatment may be sufficient. This means that the fracture is manually “set up” by us, i.e. brought into the normal position (reduction). The forearm is then plastered.
However, if an unstable fracture is present, surgical treatment is the treatment of choice for optimal restoration of the anatomy with the aim of maintaining >function in the long term.
The procedure is performed either under plexus anesthesia or under general anesthesia. The surgeon puts the fragments back into their correct position and fixes them with screws, plates and/or wires. In certain situations, definitive fixation of the fracture fragments cannot be performed directly, in which case an external fixator may be necessary initially and the definitive treatment is performed after the swelling of the forearm has subsided.
Radius fracture: various surgical techniques
Fixation with wire: This surgical method, which has often been used historically, is only used in exceptional cases in adult patients. However, it is possible to combine wires with other surgical methods.
External fixator: A definitive plate and/or screw osteosynthesis is often not possible due to the soft tissue situation. In these situations, we initially fit an external fixator. This is an external stabilization with individual metal pins in the metacarpal and the radius for a few days. Once the soft tissue has subsided, the external fixator is removed again in a second operation and the fracture is definitively treated.
Screw fixation: In certain fracture configurations, we can surgically screw the fragments together. The screws are usually countersunk below the bone surface and are left in place permanently.
Implantation of metal plates: The fracture fragments are usually fixed with a plate on the inside of the forearm; in some cases, a plate on the back of the radius is also necessary.
In the case of complex fractures, wrist endoscopy may be necessary during surgical treatment in order to optimally adjust the joint surface. Once the fracture has healed, the metal plates can be removed depending on the symptoms. They are often left in place for life. The aim of fixation with screws and plates is to ensure rapid mobilization after the operation.