DESCRIPTION AND SYMPTOMS
WHAT KINDS OF RADIU FRACTURES EXIST?
Once we know that the radius has broken, we must know what type of fracture we have. It can be a joint fracture (affecting the joint, that is, at the far end of the radius) or a non-joint fracture (not affecting the joint). This detail is important because it can have functional consequences for our wrist.
- Extra-articular fractures, sometimes misnamed Colles’ fracture, are fractures that affect the end area of the radius but not the joint. Depending on where the fracture extends to, we can refer to a non-joint fracture as a Colles’ fracture, Smith fracture, etc.
- Intra-articular fractures are fractures that extend into the joint itself. They can be more serious fractures because if the break is greater than 2 mm, long-term complications can arise.
Radius fractures are very common in women and in people with osteoporosis because osteoporosis makes bones more fragile, so less force is needed to break them. For this reason, a wrist fracture can be the first sign of weak bones and are more frequent in menopausal women (when hormonal changes have been known to lead to osteoporosis).
Other related wrist injuries:
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SYMPTOMS AND DIAGNOSIS OF A RADIUS (WRIST) FRACTURE
Clinically, a radius fracture is recognized by:
Deformity (known as a “back of fork” deformity), which is due to the posterior displacement of the distal segment of the radius.- Pain, mainly localized in the back (dorsal) and side (radial) area of the wrist, but occasionally in other areas of the wrist when ulna fractures or ligament injuries are also present.
Deformity (known as a “back of fork” deformity), which is due to the posterior displacement of the distal segment of the radius.Diagnosis of a wrist fracture is made with an x-ray. Sometimes if the fracture is complex, it is necessary to request a computerized tomography (CT scan) to obtain a 3D image of the break.
IF THE INJURY IS NOT TREATED IN TIME
When not treated correctly, many patients experience serious long-term consequences such as chronic pain or functional limitations needed to perform wrist movements. If not remedied, the wrist will not perform as it should, which will lead to problems in many areas of life.
Work
The wrist is essential for any job, whether physical or mental, so the loss of strength in the joint will prevent normal working activities.
Sport
Athletes who do not treat wrist fractures will find it difficult to exercise, especially those in racket sports like basketball, handball, and weightlifting.
Stiffness
If not treated properly, the patient may lose mobility in the wrist.
TREATMENT
WHAT IS THE TREATMENT FOR A RADIUS FRACTURE?
If the fracture is small enough that the bone hasn’t fully broke (a non-displaced, or hairline fracture), it will be treated with a cast. The immobilization time is usually between 4 and 5 weeks. On-going x-rays will be required to see that the fracture is healing correctly (i.e. remains in place and does not move). After the cast is removed, the patient will require physical therapy treatment to gain mobility and strength in the hand.
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Larger fractures where the bone has broken into two or more pieces, called displaced fractures, require returning the bone to its proper place. Depending on the type of fracture, surgical treatment may or may not be used. That is to say, there are some fractures that are sufficiently stable after resetting the bone to require no additional support to keep the bone in place while it heals. In highly displaced or unstable fractures, however, surgical treatment is required after resetting the bone in order to keep it in place long enough to heal.
HOW IS WRIST SURGERY PERFORMED FOR A BROKEN RADIUS?
In all radius fractures we seek the same goal: “anatomical reduction”. That is, resetting all the broken fragments back into the correct place so that they can heal properly. The goal, in essence, is to put the puzzle back together.
To do this, we make an incision of about 3 cm at the front (palm) area of the wrist. The fracture is identified, reset (the fragments are pit back into place), and fixed with a plate and screws.
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In most cases we complement this treatment with a wrist arthroscopy, where we introduce a camera into the joint with two objectives: to find and assess any associated injuries in the ligaments, and to check that all the bone fragments have been properly reset. Additionally, x-rays are also performed within the operating room to verify with total precision that the resetting of the bone has been performed perfectly.
See an animation for surgical technique for a fixed plate radius fracture without arthroscopic assistance) here:
https://www.arthrex.com/es/recursos/animacion/YnJwrymw2k-8cAFGSUqEEA/distal-radius-fracture-repair
FREQUENTLY ASKED QUESTIONS
How long does an arthroscopic surgery for a wrist fracture take?
Duration time varies depending on factors such as the surgeon’s experience, the type of injury being treated, and the characteristics of the patient, but the average procedure usually takes between 45 and 90 minutes.
What is recovery like after a wrist fracture?
Optimal recovery after an arthroscopic surgery for a broken wrist requires following a series of guidelines such as:
- Keeping the wrist elevated above the level of the heart (to reduce pain and inflammation), for 10-15 days.
- Keeping the dressing clean and dry.
- Taking prescribed pain relievers in adequate doses.
- Keeping the splint on for as long as the surgeon recommends.
What are possible complications after arthroscopic wrist surgery for fractures?
Among the main complications following wrist fracture are:
- Stiffness in the wrist.
- Post-traumatic osteoarthritis: especially in joint fractures whose resetting has not been executed perfectly.
REFERENCES
Johnson NA, Dias J.The current evidence-based management of distal radial fractures: UK perspectives. J Hand Surg Eur Vol. 2019 Jun;44(5):450-455. doi: 10.1177/1753193419843201. Epub 2019 Apr 16. Review. PMID:30991865
If you want to learn about arthroscopic surgery for wrist fractures or would like to speak with someone regarding your specific situation, you can speak with Dr. Villanova directly by clicking here:
This post is also available in: Spanish
