Distal radius fractures are a very common injury of the radius that occur at the distal end, where the wrist joint lies. The most common cause of this type of fracture is when an individual falls on an outstretched hand (mnemonic: FOOSH).

Patients usually present with localized pain, injuries associated with the physical trauma, and scaphoid fracture. If the anatomy is not properly restored, function may remain poor even after healing.

Contents

1 Investigation 1.1 Lateral articular angle 1.2 Radial length 1.3 Articular surface 2 Management

Investigation

Investigation of a potential distal radial fracture includes assessment of the lateral articular angle, radial length, and articular surface.

Lateral articular angle

The lateral articular angle is the angle between the axis of the radius and the articular cup. Usually, the angle is turned down toward the thumb by 12°. This is normal alignment. As pressure is applied to the radius, the cup may become aligned differently. Alignment up to 0° is still considered to be functional, and does not require any intervention. However, anything beyond this point (>12° deviation) requires action. When this occurs, distal radio-ulnar joint motion is altered, and forearm rotation becomes restricted.

Radial length

Radial length is one of the important considerations in a distal radius fracture. The core question that must be answered "is it short?" The radius length would be too short if there is greater than neutral variance, especially when compared to the opposite side of the body. If the radial length remains uncorrected, ulnar impaction syndrome may occur.

Articular surface

Any articular joint surface must be smooth for it to function properly. The surface is not smooth if there is more than 1mm step deformity, and is associated with posttraumatic arthrosis. Irregularity may result in radiocarpal arthritis, pain, and stiffness. If the surface is very irregular, the optimal treatment is fusion.

Management

Management of a distal radius fracture involves first anesthetizing the affected area with a hematoma block , regional anesthesia or sedation.

Treatment includes first placing the arm under traction. This increases the deformity, and unlocks fragments. The deformity is then reduced with a closed reduction, after which a cast is made and an X-ray is taken to ensure that the reduction was successful.

It should be noted that this is frequently unsuccessful in maintaining a good position in adults, because there is frequently comminution of the fracture. Surgical options include ORIF , external fixation , percutaneous pinning , or some combination of the above.