A distal radius fracture is a common break in the larger of the two bones in the forearm, located near the wrist joint. This type of fracture often occurs when a person falls onto an outstretched hand. Surgery becomes necessary for displaced or unstable fractures to properly realign the bone fragments and stabilize them, aiming to restore the wrist’s anatomy and function. While surgical treatment generally leads to good outcomes, it is important to understand the potential complications that can arise following this procedure, ranging from immediate post-operative issues to those that develop over a longer period.
Common Early Complications
Early complications appear within days to a few weeks after distal radius fracture surgery. Surgical site infection is a concern, though the hand’s good blood supply makes severe infections rare; signs often include redness, pain, and swelling developing a few days post-operation. Superficial infections can be managed with dressings or oral antibiotics.
Nerve injuries can also occur, affecting 2% to 8% of patients. The median nerve is most frequently affected, leading to symptoms such as numbness, tingling, or even acute carpal tunnel syndrome. The radial and ulnar nerves can also be injured during surgery or due to the initial trauma or swelling.
Bleeding or hematoma formation can occur at the surgical site. Excessive swelling in the hand and wrist is another common early issue, which can sometimes lead to increased pressure within the tissues, a condition known as compartment syndrome. Acute, unmanageable pain that persists beyond the initial few days after surgery can signal an underlying problem.
Potential Long-Term Complications
Complications can also manifest weeks, months, or even years after distal radius fracture surgery. Malunion, where the fracture heals in an improper position, is considered the most common long-term complication. This can result in decreased grip strength, limited wrist movement, and chronic pain, sometimes due to incongruity or impaction in the distal radio-ulnar joint.
Nonunion, the failure of the fracture to heal, is a less common but serious complication. Stiffness and limited range of motion in the wrist and fingers are frequent occurrences after surgery, even with successful healing, and may require ongoing physical therapy. Post-traumatic arthritis can develop in the wrist joint, especially if the fracture extended into the joint surface, leading to pain and reduced function over time.
Tendon irritation or rupture, particularly of the extensor pollicis longus (EPL) tendon, can result from the proximity of tendons to the surgical hardware. Tendon ruptures typically occur around 7 weeks post-surgery but can happen earlier. Hardware-related issues, such as plate prominence or screw loosening, can cause discomfort, tendon irritation. Complex Regional Pain Syndrome (CRPS) is a complex condition characterized by persistent pain, swelling, and changes in skin color and temperature, which can occur after a distal radius fracture.
Recognizing Signs of a Complication
Recognizing the signs of a potential complication early can improve outcomes. Persistent or worsening pain beyond what is expected for recovery, especially if it does not improve with medication, warrants attention. Unusual or increasing swelling, redness, or warmth around the incision site, particularly if it develops a few days after surgery, could indicate an infection.
Any discharge from the incision site is also a concerning sign. Numbness or tingling in the fingers or hand may suggest nerve irritation or injury. Inability to move fingers or the wrist should also prompt medical evaluation. Changes in skin color or temperature could indicate circulation problems. If any of these signs appear, it is important to contact the surgeon promptly for evaluation.
Addressing Complications and Recovery
When a complication is suspected after distal radius fracture surgery, various diagnostic steps are employed. X-rays are the first step to assess bone alignment and hardware position, while nerve studies may be conducted to evaluate nerve function. Further imaging, such as CT scans or MRI, might be used for detailed views of bone healing or soft tissue structures.
Management approaches vary depending on the specific complication. Non-surgical interventions may include adjustments to physical therapy regimens, different pain medications, or the use of splints to support the wrist. For issues like tendon irritation, activity modification may be recommended. In some cases, surgical revisions are necessary. The overall recovery time and prognosis depend significantly on the type and severity of the complication and the effectiveness of the chosen treatment pathway.