Distal Radius Fractures: Understanding Treatment Options for a Broken Wrist
By Dr. Oren Michaeli, DO – Board Certified General Surgeon, Fellowship-Trained in Hand Surgery, Microsurgery, and Peripheral Nerve Surgery
Introduction
A distal radius fracture, or a broken wrist, is one of the most common orthopedic injuries. It can occur from a variety of causes, such as falling on an outstretched hand, sports injuries, or motor vehicle accidents. Despite its prevalence, treatment for distal radius fractures is not one-size-fits-all. The best approach depends on the severity of the fracture, the patient’s overall health, and their willingness to adhere to the treatment plan.
At Hand, Nerve & Microsurgery PC, I offer comprehensive care for wrist fractures, including both non-operative and surgical options such as casting, plate fixation, and headless compression screw placement. Understanding your options is key to making an informed decision about your care.
What Is a Distal Radius Fracture?
The radius is one of the two long bones in the forearm, and its distal end (near the wrist) plays a crucial role in wrist mobility and strength. When this part of the bone fractures, it can significantly impact daily activities like gripping, lifting, or twisting the hand.
There are several types of distal radius fractures:
Extra-Articular Fracture: The break does not extend into the joint.
Intra-Articular Fracture: The break extends into the joint surface, potentially causing long-term joint dysfunction.
Displaced Fracture: The bone fragments have shifted out of alignment.
Nondisplaced Fracture: The bone fragments remain aligned.
Radial Styloid Fracture: A fracture involving the bony prominence on the thumb side of the wrist.
Non-Operative Treatment: When Casting Is Appropriate
Non-operative treatment is often sufficient for certain types of distal radius fractures, particularly in the following scenarios:
Nondisplaced Extra-Articular Fractures:
These fractures maintain proper alignment and are stable.
Patients willing to commit to rigid casting for 4–6 weeks may achieve full healing without surgery.
Patients Unwilling or Unfit for Surgery:
Some individuals may not want surgery or may have medical conditions that make surgical risks unacceptable. While casting may be a viable option for these patients, it’s important to note that non-surgical management in certain types of fractures can lead to complications such as persistent pain, stiffness, or long-term loss of motion. Patients should carefully weigh these risks against their preferences and overall health before choosing a treatment plan.
Casting Process:
The wrist is typically immobilized in a short arm cast that stabilizes the fracture while allowing the bone to heal naturally. Regular follow-up appointments are critical to monitor alignment and ensure proper healing.
When Is Surgery Necessary?
Surgical intervention is recommended for more complex fractures or those unlikely to heal properly with casting alone. Indications for surgery include:
Displaced Fractures:
When the bone fragments are no longer in proper alignment, they often require reduction (realignment) and fixation to ensure proper healing and wrist function.
Intra-Articular Fractures:
If the fracture extends into the joint, surgical fixation is usually required to restore the joint surface and prevent long-term arthritis or loss of motion.
Unstable Fractures:
Some fractures are inherently unstable and at risk of further displacement even after initial realignment. These often require surgical stabilization.
Failure of Non-Operative Management:
If a fracture initially treated with casting shifts or fails to heal adequately, surgery may become necessary.
Operative Fixation Options
Surgical fixation techniques for distal radius fractures include:
Plate Fixation (Open Reduction and Internal Fixation - ORIF):
A small incision is made, and a metal plate with screws is used to secure the bone fragments in place.
Ideal for intra-articular fractures or fractures with multiple fragments.
Headless Compression Screw for Radial Styloid Fractures:
For fractures isolated to the radial styloid, a headless compression screw provides stable fixation while minimizing disruption to surrounding tissues.
This option is less invasive than plate fixation and is ideal for select cases.
Recovery After Surgery:
Most patients wear a splint for a brief period after surgery, followed by a structured physical therapy program to regain strength, motion, and function.
Hardware (plates or screws) is typically left in place unless it causes discomfort or complications.
Advantages and Limitations of Each Approach
Casting (Non-Operative Treatment)
Advantages:
Non-invasive and avoids the risks associated with surgery.
Effective for stable fractures that remain well-aligned, particularly nondisplaced extra-articular fractures.
A good option for patients who are medically unfit or unwilling to undergo surgery.
Limitations:
May lead to persistent stiffness, pain, or deformity, especially in fractures that are displaced or unstable.
Requires strict adherence to immobilization for 4–6 weeks, which can be challenging for some patients.
Less effective for intra-articular or unstable fractures, increasing the risk of long-term complications.
Plate Fixation (Surgical Treatment - ORIF)
Advantages:
Provides stable fixation, making it ideal for displaced, intra-articular, or comminuted fractures.
Restores alignment and allows for early mobilization, reducing the risk of stiffness.
Highly reliable for maintaining long-term wrist function and strength.
Limitations:
Involves surgical risks, such as infection, stiffness, or hardware irritation.
Requires recovery time, and some patients may need physical therapy for optimal outcomes.
May not be necessary for simpler, stable fractures that can heal with casting.
Headless Compression Screw (Radial Styloid Fractures)
Advantages:
A minimally invasive option specifically for isolated radial styloid fractures.
Preserves surrounding tissues, resulting in less disruption and faster recovery compared to plate fixation.
Provides precise fixation and excellent outcomes in selected cases.
Limitations:
Limited to specific fracture patterns and not suitable for complex or intra-articular fractures.
Requires surgical expertise to ensure accurate placement of the screw.
Recovery and Rehabilitation
Whether treated non-operatively or surgically, proper rehabilitation is critical for regaining function. Key components include:
Occupational Therapy: Exercises to improve range of motion, grip strength, and coordination.
Pain Management: Medications and ice therapy may be used to control discomfort during the recovery period.
Follow-Up Care: Regular visits ensure the bone is healing properly, whether in a cast or after surgery.
Full recovery can take anywhere from 6 weeks to several months, depending on the severity of the fracture and the treatment approach.
Why Choose Dr. Oren Michaeli at Hand, Nerve & Microsurgery PC?
Expertise in Wrist Fractures: As a fellowship-trained hand surgeon, I bring extensive experience in managing distal radius fractures with both non-operative and surgical techniques.
Patient-Centered Care: I tailor treatment plans to each patient’s needs, ensuring the best balance between recovery, function, and lifestyle.
Advanced Surgical Techniques: From precise plate fixation to minimally invasive compression screw placement, I use the latest methods to restore wrist function.
Scheduling a Consultation
If you’ve experienced a wrist injury or suspect a distal radius fracture, contact Hand, Nerve & Microsurgery PC for expert evaluation and personalized care. Our goal is to ensure your recovery is as smooth and stress-free as possible.
Phone: (212) 540-4263
Email: Info@handnervemicrosurgery.com
Office: 570 Sylvan Ave, 2nd Floor, Englewood Cliffs, NJ 07632
Video Consultations: For added convenience, we offer virtual consultations to evaluate your injury and discuss treatment options.
