What are the Treatment Options for Distal Radius Fractures? A Guide by a Hand Surgeon

As a Board-Certified Hand Surgeon, I frequently encounter patients who have sustained distal radius fractures, which are among the most common types of fractures involving the wrist. These injuries can occur due to various causes, including falls, sports injuries, and motor vehicle accidents. Treating distal radius fractures requires careful consideration of factors such as fracture severity, patient age, and activity level. In this blog post, I’ll discuss the different treatment options available for distal radius fractures and factors to consider when determining the most appropriate approach for each patient.

Non-Surgical Treatment:

In cases where the fracture is stable and minimally displaced, non-surgical treatment may be sufficient to promote healing and restore function. This approach typically involves immobilizing the wrist with a splint or cast to allow the fractured bones to heal properly. The duration of immobilization may vary depending on the severity of the fracture and the individual patient’s healing response. X-rays are taken in the office during recheck visits sequentially to confirm proper healing. Typically, fractures of the distal radius or distal ulna require 4-6 weeks of immobilization to heal. This includes fractures that occur in children and adults. For some children, a long-arm cast (ie cast above including the elbow) may be required to ensure stability and proper healing of the fracture.

Non-surgical treatment is often recommended for:

1. Stable fractures with minimal displacement
2. Fractures in elderly patients or those with significant medical co-morbidities
3. Fractures in patients who are unable or unwilling to undergo surgery

During the healing process, patients may be advised to perform gentle range-of-motion exercises to prevent stiffness and maintain flexibility in the fingers and wrist. Follow-up appointments with a hand therapist or physiotherapist may be recommended to monitor progress and guide rehabilitation efforts.

Surgical Treatment:

For more complex or displaced distal radius fractures, surgical intervention may be necessary to realign the fractured bones and restore stability to the wrist joint. Surgical treatment options for distal radius
fractures include:

1. Open Reduction and Internal Fixation (ORIF): This surgical technique involves making an incision over the fractured area to realign the bones into their proper position. The fractured fragments are then held
together with the use of metal plates, screws, or pins to stabilize the wrist joint during the healing process. ORIF is often recommended for fractures with significant displacement or instability.

2. External Fixation: In some cases, an external fixator may be used to stabilize the wrist joint while the fracture heals. This involves placing pins or screws into the fractured bones, which are then connected to an external frame outside the body. External fixation may be used as a temporary measure to stabilize the fracture before definitive treatment with ORIF or as a primary treatment option in certain situations.

3. Closed Reduction and Casting: In select cases, a technique known as closed reduction may be performed to realign the fractured bones without the need for surgery. Once the bones are properly aligned, a cast or splint is applied to immobilize the wrist and facilitate healing. Closed reduction and casting may be suitable for certain types of fractures, particularly in patients with good bone quality and minimal displacement.

Factors to Consider:

When determining the most appropriate treatment approach for a distal radius fracture, several factors must be considered, including:
• Severity and displacement of the fracture
• Patient age and activity level
• Overall health and medical history
• Patient preferences and goals for recovery

Conclusion:

Distal radius fractures are common injuries that can significantly impact wrist function and quality of life. The choice of treatment for these fractures depends on various factors, including the severity of the injury, patient characteristics, and individual preferences. Whether treated non-surgically or with surgical intervention, the primary goal is to achieve optimal fracture healing, restore wrist function, and minimize complications. If you’ve sustained a distal radius fracture, it’s essential to consult with a hand
surgeon to discuss your treatment options and develop a personalized plan for recovery. With proper care and attention, most patients can expect to regain function and return to their normal activities following treatment for a distal radius fracture.

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