Fracture of the distal radius (arm) is one of the most common fractures. The majority of these fractures are in two distinct populations: youth who are involved in sports and sustain a relatively high-energy fall, and seniors with osteoporosis who fall with low energy.
How the injury occurs: The most common mechanism is Falling On an Out-Stretched Hand (FOOSH), with extension of the wrist (backward bending).
Indications for referral to surgeon: Most of the time distal radius fractures can be managed by your primary care physician. There are some circumstances however which require referral to a surgeon such as:
1) Open fractures – ie. Fractures with laceration of skin above the bone
2) Fractures where there is pressure building up in the soft tissues of the wrist due to ongoing bleeding
3) Fractures where the nerves of the hand/wrist are damaged
4) Other fractures that are unstable
Treatment: We usually don’t put a cast on immediately after the injury because of the swelling, and risk of decreased blood flow due the injured area that can occur inside the cast. For non-displaced extra-articular fractures, we usually treat with a well-molded sugar tone, reverse sugar tong or double sugar tong splint. The elbow is usually flexed to 90 degrees and the arm is in a neutral position. The arm is kept in a splint for a few days following the injury and should do the following:
1) Elevate the arm
2) Apply ice to the fracture frequently (while keeping the splint dry)
3) Begin active range of motion to the shoulder and fingers
4) Use pain medication as needed
Patients are seen 3-5 days after the injury to evaluate, remove the splint and assess neurovascular status. We often repeat x-rays at this time with the arm out of the splint. If the fracture still looks non or minimally displaced, the healthcare provider then applies a short arm cast. The cast will extend from the distal palmar crease to within 5cm of the antecubital fossa. The patient is by their healthcare provider every 2-3 weeks until the healing is complete. Patients should remain in the cast until there is evidence of radiographic healing or the fracture is non-tender and that is generally for 6 weeks. At this point, a wrist brace can be used instead of the cast. Complete healing can require 6-8 weeks.
If there is initial displacement of the bones on x-ray, the splint is usually kept in place for 2-3 weeks, then changed to a short arm cast with immobilization for another 4-5 weeks. Healing of these displaced fractures usually takes 8-12 weeks.
Possible complications: Injury to the medial nerve or compartment syndrome are the most important and early complications of a distal radius fracture. Acute Carpal Tunnel Syndrome (ACTS) is a nerve injury to the medial nerve that sometimes occurs with a traumatic fracture. Signs of compartment syndrome include increasing or constant severe pain or pain elicited by passive extension of the fingers. These symptoms usually start within 12-54 hours after the injury, so it is important for the patient to tell their physician if their pain is worsening during this time.
Injury to other bones within the hand/wrist can accompany a distal radius fracture, but they are rare. They are suspected in patients with persistent wrist pain despite acceptable alignment.
Return to work: Patients with more sedentary jobs may return to work immediately. Physical laborers may return to full duty of after they have regained near-normal wrist motion and strength. It is reasonable for participants in contact sports also to delay return to play until they have achieved near-normal motion and strength, and to wear a protective palmar splint during the first few weeks of play.
Splint Care: a cast or splint will help protect the injured bone or tendons and reduce pain as you heal. It is important to take care of the splint to minimize risk of possible problems such as a skin infection.
Splint care instructions:
1) Swelling is common and can make your splint feel tight initially. To reduce the swelling we recommend keeping the splint above the level of your heart for 24-48 hours. Resting the splint on pillows or having your arm or leg in a sling that keeps the extremity elevated is important.
2) Gently move your fingers or toes (where the splint is located) frequently.
3) Ice can help keep the swelling down. Apply ice or a frozen bag of vegetables to the injured area. Do not apply blue ice (mostly used for camping) directly to the skin because this can cause freezer burn.
4) Do not get the splint wet. Bathe with the splint covered in a plastic bag and tape the opening shut to prevent damaging it. Hang the splint outside of the bathtub if possible.
5) If the splint becomes wet, dry it with a hair dryer on the cool setting. Using a hot setting can burn the skin.
6) Keep the splint clean and avoid getting dirt or sand into it. Do not apply powder or lotion on or near the splint and cover the splint when eating.
7) Don’t place anything inside the splint, even for areas the itch. Sticking things inside the splint can injure the skin and lead to infection. Do not pull the padding out from inside the splint.
When to seek help for your splint:
1) Your fingers or toes get cold or blue, hurt, get numb, tingle or throb – this may indicate the splint is too tight
2) There are sore areas or a foul odor from the splint
3) If the splint breaks or is damaged
4) If you develop severe pain in or near the splinted arm or leg
5) If the splint becomes soaking wet or does not dry with a hair dryer or vacuum.
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO