Broken Wrist (Distal Radius Fracture): Treatment Options

Overview

A distal radius fracture, commonly called a broken wrist, is the most common fracture in adults under 75. It occurs when the radius (the larger forearm bone) breaks near the wrist, typically from a fall on an outstretched hand. In younger patients, significant force is usually required; in older adults with osteoporosis, a low-energy fall can cause the same fracture.

Types of Distal Radius Fracture

Colles fracture, the most common type; the broken fragment tilts backward (dorsal angulation). Smith fracture, the fragment tilts forward; typically from a fall on a flexed wrist. Intra-articular fractures extend into the wrist joint surface and require more precise reduction and fixation.

Symptoms

• Immediate wrist pain and tenderness
• Swelling, bruising
• Deformity — a "dinner fork" appearance in a displaced Colles fracture
• Reduced grip strength and wrist movement

Diagnosis is confirmed with wrist X-rays. CT may be requested for complex intra-articular fractures.

Non-Surgical Treatment

Undisplaced or minimally displaced fractures, and many stable displaced fractures (after manipulation), can be managed in a plaster cast for 4–6 weeks. This is suitable for older, less active patients who are tolerant of a degree of malunion, or for fractures that hold their position well after reduction.

Surgical Treatment

Surgery is recommended for:

• Unstable or significantly displaced fractures
• Intra-articular fractures requiring anatomic reduction
• Young, active patients or manual workers who require the best possible outcome
• Fractures that redisplace after initial casting

The most common operation is volar locking plate fixation, a plate is applied to the front of the radius through a small incision on the palm side of the wrist. Screws lock the fractured fragments in their corrected position, allowing early wrist movement.

Recovery

After plaster treatment, physiotherapy is important to restore wrist movement and grip strength, typically over 6–12 weeks. After surgical fixation, movement begins within days and most patients regain full or near-full function by 3–6 months. Return to manual work or sport depends on the nature of activities and fracture complexity.

Further Reading

Dr Yu has written in more detail about this topic on his own site: fractures and dislocations and wrist conditions.