Distal Radius Fracture
What is it: The most common distal radius fracture is a Colles' fracture, which is an extra-articular fracture of the distal radius.
How does it present: The injury usually occurs after a fall on an outstretched hand, but direct trauma to the wrist can also cause the injury. The patients will often present with swelling, bruising and pain over the distal radius and pain with range of motion.
Common exam findings: Evidence of the swelling and ecchymosis can be seen on exam. Tenderness over the fracture site can also be elicited. It is important to document a neurovascular exam as the median nerve, radial artery and tendon of the extensor pollicis longus are often very close to the fracture site.
Tests and treatment: Distal radius fractures are usually seen on x-rays. It is important to triage distal radius fractures appropriately before managing. Distal radius fractures can be classified according to the Frykman classification system, which classifies fractures into one of eight types. The types are paired, such that type I and II are extra articular fractures without and with associated ulna styloid fractures. Types III though VIII involve the radiocarpal, radioulnar or both radiocarpal and radioulnarjoints either without or with associated ulna styloid fractures. Types III through VIII should be considered for referral to orthopedics. Also in the typical Colles' fracture, the distal fracture fragment, if angulated, is displaced dorsally. Up to 20 degrees of dorsal angulation is acceptable without manipulation. Another type of extra articular distal radius fracture is the Smith's fracture. These are usually caused by a direct blow to the back of the wrist or falling on the back of the wrist. In these fractures the distal fragment angulates volarly. This is an unstable fracture that should be referred to orthopedics. In Colles' fractures there may also be shortening of the radius and up to one centimeter of shortening is acceptable. If the distal radius fracture is appropriate to treat, it is extra articular and non-displaced or within acceptable limits for angulation and shortening, it is appropriate to treat initially with a double sugar tong splint which can be replaced with a short arm cast within a week once swelling has decreased. Immobilization is usually four to six weeks and return to function should be monitored after the immobilization.