Distal Radius Fracture (Wrist Fracture; including Colles and Smith fracture patterns)

Also known as: Distal radius fracture, Wrist fracture, Broken wrist, Fracture of the distal radius, Distal radial fracture, DRF (distal radius fracture), Colles fracture, Smith fracture

Last updated: December 18, 2024

A distal radius fracture is a break in the radius bone near the wrist joint, with fracture lines that may extend into the joint. It often follows a fall on an outstretched hand and can show displacement patterns such as a Colles fracture (dorsal angulation) or Smith fracture (volar angulation). Symptoms include wrist pain, swelling, and tenderness that limit motion. Treatment may begin with splint immobilization. Recovery varies.

Key Facts

•A distal radius fracture describe a break in the radius bone near the wrist joint and include extra-articular or intra-articular fracture lines
•Wrist pain that be immediate after injury and worsens with movement or gripping
•Diagnosed through history, physical exam, and imaging
•First-line treatment includes exercise, weight management, and activity modification

What It Is

A distal radius fracture may describe a break in the radius bone near the wrist joint and can include extra-articular or intra-articular fracture lines. The injury often occurs after a fall onto an outstretched hand and may produce characteristic displacement patterns such as a Colles fracture (typically dorsal angulation) or a Smith fracture (typically volar angulation). Depending on energy of injury and bone quality, the fracture can be minimally displaced, comminuted, or associated with ligament injury and instability of the distal radioulnar joint. Swelling and altered alignment can affect wrist mechanics and may contribute to stiffness, reduced grip strength, and functional limitation during healing.

Affected Anatomy

This condition affects several structures in and around the joint:

•Distal metaphysis of the radius (including dorsal and volar cortices)
•Radiocarpal joint surface (distal radius articular surface, including the scaphoid and lunate fossae)
•Distal radioulnar joint (DRUJ) and sigmoid notch of the radius
•Ulnar styloid process (often involved as an associated fracture)
•Triangular fibrocartilage complex (TFCC)
•Scapholunate ligament complex (carpal stabilizing ligaments)
•Median nerve within the carpal tunnel (potential compression with swelling)
•Extensor pollicis longus tendon (risk of irritation or delayed rupture in some patterns)

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

•Wrist pain that may be immediate after injury and can worsen with movement or gripping
•Swelling and tenderness around the distal radius and wrist that may limit range of motion
•Visible deformity or abnormal wrist contour that can resemble a "dinner fork" appearance in some dorsal displacement patterns
•Bruising and warmth around the wrist and forearm that may develop over hours to days
•Reduced grip strength and difficulty using the hand for daily activities, often due to pain and mechanical limitation
•Numbness, tingling, or altered sensation in the thumb, index, and middle fingers that may suggest median nerve irritation or compression
•Pain with forearm rotation (pronation/supination) that can reflect DRUJ involvement or associated soft-tissue injury
•Stiffness that may persist after immobilization and can affect wrist flexion/extension and finger motion

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

•Low-energy fall onto an outstretched hand, which often transmits force to the distal radius and can produce dorsal displacement patterns
•High-energy trauma such as motor vehicle collisions or sports impacts, which may cause comminution, intra-articular extension, or associated injuries
•Direct blow to the wrist or forearm, which can create fracture lines and soft-tissue injury depending on direction of force
•Bone fragility related to osteoporosis or osteopenia, which can lower the force threshold needed for fracture
•Repetitive stress in select activities, which can rarely contribute to stress-related distal radius injury patterns

Risk Factors

•Older age, which can be associated with reduced bone mineral density and higher fall risk
•Osteoporosis or osteopenia, which can increase susceptibility to fractures after low-energy trauma
•Female sex after menopause, which often correlates with accelerated bone loss
•History of prior fragility fracture, which may indicate underlying skeletal fragility
•Participation in activities with fall risk (ice sports, skiing, cycling) or contact sports, which can increase exposure to wrist trauma
•Balance impairment, vision impairment, or neurologic conditions that can increase likelihood of falls
•Use of medications that can contribute to falls (sedating agents) or reduced bone density (long-term systemic corticosteroids)
•Occupational or recreational exposure to high-energy mechanisms (construction, climbing), which can increase risk of complex fracture patterns

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

•Clinical history and mechanism assessment, including description of fall direction, hand position, and immediate functional changes
•Physical examination of the wrist and hand, often including inspection for deformity, palpation for point tenderness, and assessment of wrist and finger range of motion as tolerated
•Neurovascular assessment, typically including capillary refill, radial and ulnar pulses, and sensory testing in median, ulnar, and radial nerve distributions
•Plain radiographs (X-rays) of the wrist, generally including multiple views to evaluate displacement, comminution, radial height, radial inclination, and volar/dorsal tilt
•Computed tomography (CT), which can help characterize intra-articular involvement, comminution, and alignment for complex fractures
•Magnetic resonance imaging (MRI) in select cases, which can evaluate associated ligament injury (such as TFCC or scapholunate injury) when symptoms persist or instability is suspected
•Follow-up imaging during healing, which can monitor maintenance of reduction and progression of bone union, particularly in displaced or unstable patterns

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

•Initial immobilization with a splint, which can reduce motion and may help control pain and swelling while definitive evaluation occurs
•Closed reduction (manual realignment) for displaced fractures, often followed by immobilization to maintain alignment
•Casting or bracing for stable or successfully reduced fractures, with duration that can span several weeks depending on fracture characteristics and healing progress
•Elevation and cold application strategies, which can help limit swelling in the early period after injury
•Percutaneous pinning (K-wires) in select fracture patterns, which can provide stabilization with less extensive exposure than plating
•External fixation for certain unstable or comminuted fractures, sometimes combined with pins or internal fixation depending on pattern and soft-tissue status
•Management of associated injuries, which can include evaluation and treatment of ulnar styloid fracture, DRUJ instability, TFCC injury, or acute median nerve compression when present

Physical Therapy and Exercise

•Hand therapy or supervised rehabilitation, which can focus on restoring wrist and finger motion, reducing stiffness, and improving strength after immobilization

Medications

•Analgesic medications such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), which may be used for symptom control depending on individual factors

Surgery

•Surgical fixation with plates and screws (often volar locking plate fixation) for unstable, significantly displaced, or intra-articular fractures where alignment may be difficult to maintain nonoperatively

Prognosis and Recovery

The course of this condition varies between individuals:

•Functional recovery can vary widely and may depend on fracture displacement, intra-articular involvement, stability, and patient factors such as age and bone quality
•Many fractures can heal with restoration of useful wrist function, although stiffness and reduced grip strength may persist for a period after immobilization
•Intra-articular fractures can increase the likelihood of post-traumatic arthritis and chronic pain, particularly when joint congruity remains altered
•Complications such as malunion, loss of reduction, or tendon irritation can occur in some cases and may influence long-term motion and strength
•Median nerve symptoms related to swelling can improve as swelling resolves, although persistent or progressive symptoms can indicate more significant compression
•Return to higher-demand activities can require a gradual progression and may span months, especially after complex fractures or surgical fixation

Open Reduction and Internal Fixation (ORIF)(Procedure)
Closed Reduction (Fracture Reduction Without Incision)(Procedure)

Frequently Asked Questions

Common symptoms include: Wrist pain that may be immediate after injury and can worsen with movement or gripping; Swelling and tenderness around the distal radius and wrist that may limit range of motion; Visible deformity or abnormal wrist contour that can resemble a "dinner fork" appearance in some dorsal displacement patterns; Bruising and warmth around the wrist and forearm that may develop over hours to days; Reduced grip strength and difficulty using the hand for daily activities, often due to pain and mechanical limitation.

Diagnosis typically involves: Clinical history and mechanism assessment, including description of fall direction, hand position, and immediate functional changes; Physical examination of the wrist and hand, often including inspection for deformity, palpation for point tenderness, and assessment of wrist and finger range of motion as tolerated; Neurovascular assessment, typically including capillary refill, radial and ulnar pulses, and sensory testing in median, ulnar, and radial nerve distributions; Plain radiographs (X-rays) of the wrist, generally including multiple views to evaluate displacement, comminution, radial height, radial inclination, and volar/dorsal tilt.

Treatment options range from conservative measures to surgical interventions, including: Initial immobilization with a splint, which can reduce motion and may help control pain and swelling while definitive evaluation occurs; Closed reduction (manual realignment) for displaced fractures, often followed by immobilization to maintain alignment; Casting or bracing for stable or successfully reduced fractures, with duration that can span several weeks depending on fracture characteristics and healing progress; Elevation and cold application strategies, which can help limit swelling in the early period after injury; Analgesic medications such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), which may be used for symptom control depending on individual factors.