Once diagnosed, treatment of distal radius fractures may vary. If the fracture has not displaced bones or has not displaced them very much, it can be treated non-surgically.
It is important to understand at this stage that the focus of all treatment plans is to ensure a good and functional range of movement at the wrist joint. As a result, it is entirely acceptable to allow a fracture to heal with a slight amount of displacement if that does not compromise function.
Non-surgical treatment of distal radius fractures involves immobilization of the affected arm in a splint. This may take the form of a half-cast, full cast or brace. All three methods can be effectively used with successful outcomes.
Regardless of the form of immobilization that is used, it is normal for the splint to extend above the elbow and beyond the wrist. This limits all movement at the wrist and limits turning of the forearm while allowing bending at the elbow.
If the fracture has displaced the bone beyond what is considered “acceptable,” surgery may be required. In children – especially young ones – surgery involves correcting the displacement and fixing the fracture(s) with the help of K-wires (pins). In adults, the surgery normally involves plates and screws.
After surgery, it is normal to further protect the arm by wearing a splint.
In addition to treating the distal radius fracture itself, it is important to determine if there is any instability at the DRUJ. This typically happens only in fractures that result in displaced bones and require surgery. After the distal radius fracture is fixed (either with pins or plate screws), it is important to assess stability at the DRUJ.
If the DRUJ is unstable, the TFCC needs to be stabilized either by fixing the ulnar styloid fracture or directly reattaching the TFCC using bone anchors. If the DRUJ is stable, there is usually no need to fix the ulnar styloid fracture. That piece of bone may or may not heal by itself but is unlikely to cause any further functional problems.
Distal radius fractures take about four weeks to heal in young children and about six weeks in adults. Healing is determined with the help of X-ray images.
If healed, the pins (if any) are removed. There is usually no need to remove plates and screws. Splinting is discontinued and physiotherapy begins to restore range of movement and strength.
The importance of physiotherapy, especially in adults, cannot be emphasized enough. Failure to follow through with a well-planned therapy routine can lead to problems such as stiffness and loss of function.
Happily, however, being compliant with physiotherapy almost always leads to good outcomes. Most people can expect to return to a full level of activity about three weeks after physiotherapy is started and achieve full or near full range of movement in about three months.
Conclusion
Distal radius fractures are very common injuries. However, managing these injuries requires a very thorough understanding of the complex anatomy of the distal radius, distal ulna and wrist bones. It is also imperative that the treating surgeon be fully aware of wrist motion and the functional needs of the hand.
A deep understanding of the anatomy of the nerves, carpal tunnel (a narrow path surrounded by ligaments and bones in the palm of the hand), and muscles and tendons crossing the injured area is critical. Expertise in all the above allows proper management of this injury. Furthermore, it allows a provider to diagnose and manage any associated injuries to nearby structures, which may reveal themselves at the time the injury first occurs or at a later date.
If the injury is correctly diagnosed and properly managed, nearly all patients with distal radius fractures can expect complete healing with excellent range of motion and a full return to regular activities.
UofL Health – Kleinert Kutz Hand Care is at the forefront of pioneering treatments and comprehensive care for various hand and upper extremity conditions. Our dedicated team of specialists comprises world-renowned hand surgeons, therapists and support staff, all committed to delivering the highest level of care to our patients. If you are seeking specialized care for your hand or upper extremity condition, do not hesitate to schedule an appointment with Kleinert Kutz Hand Care by calling 502-561-4263.
