Displaced Fracture of the Distal Radius before and after repair

 

Wrist fractures

 

Wrist fractures typical involve the end of the radius and are referred to as “distal radius fractures”.  These are the most common fracture of the upper extremity in adults.  The most common mechanism of injury is a ground level fall on the outstretched hand. When these fractures occur in older individuals it is often a harbinger of osteoporosis so I recommend most patients have a bone density exam to assess for osteoporosis. The links below are for more information about bone density scans and osteoporosis.

 

Dexa Scan

 

Osteoporosis

 

Many of these fractures can be treated successfully with a cast.  Some require manipulation in which the fracture is “set” or realigned before the splint or cast is placed on the arm.  X-rays are taken at 2 week intervals to ensure that the bone remains aligned in the cast.  Total cast time is generally about 6 weeks.

 

Surgical intervention is required in those cases in which the bone cannot be realigned with manipulation or in those fractures which are markedly displaced. In addition, many fractures which were set in good position initially will subside or displace in the cast over 1-2 weeks.  In these cases I recommend surgery to restore the alignment of the bone.  Surgery involves a 45 minute operation in which the fracture is re-aligned and a small plate is placed on the distal radius to hold the fragments well aligned.  I currently use the Variax plate in most cases. This is done as an outpatient procedure in which you go home after the surgery and don't stay overnight in the hospital.

 

Variax Link

 

 After surgery, the wrist is placed in a soft splint for 10 days until the sutures are ready for removal.  You may need to wear a removable splint for the next 4-6 weeks but in most patients I leave the splint off and encourage wrist motion. Rehabilitation progresses fairly quickly and most patients have full recovery at 3-6 months. Therapy is important after either surgery or non operative treatment to regain flexibility and function of the hand. For more information about the post-surgical care click on the link below

 

Post-op wrist instructions