A break in the distal radius, the larger of the two forearm bones near the wrist, is one of the most frequently occurring fractures in both adults and children. This injury, commonly called a broken wrist, accounts for approximately 15% to 25% of all broken bones seen in emergency departments. Distal radius fractures typically result from trauma, often a fall onto an outstretched hand. While many fractures heal well without an operation, the decision to pursue surgery varies widely based on the specific injury characteristics and the patient’s overall health and activity level. Physicians determine the optimal course of action to restore the wrist’s anatomy and function.
Factors Determining Treatment Path
The decision between non-surgical and surgical treatment depends entirely on the nature and severity of the fracture, assessed through imaging like X-rays and sometimes CT scans. A primary factor is the degree of displacement, referring to how far the broken bone fragments have moved from their normal position. Fractures with significant displacement, meaning the bones are severely out of alignment, are more likely to require surgery to achieve and maintain proper alignment.
Another characteristic is comminution, which describes the number of pieces the bone has broken into. A shattered bone is generally less stable and less likely to stay aligned in a cast, making surgical stabilization probable. The presence of articular involvement is also a major consideration, as this means the fracture extends into the wrist joint surface. Maintaining a smooth, precisely aligned joint surface is paramount to preventing premature arthritis and long-term dysfunction.
The overall stability of the fracture, or its likelihood of shifting out of an acceptable position after initial setting, is also a key factor. If a fracture is successfully set without surgery, repeated X-rays are necessary to check for secondary displacement. If the fracture shows signs of instability, such as excessive angulation or shortening of the radius bone, or if the alignment is not within acceptable parameters, surgery is often recommended. Patient-specific factors, including age and activity level, also influence the treatment, with younger, more active patients generally requiring stricter anatomical restoration.
Treatment Without Surgery
Non-surgical management is the preferred approach for fractures considered stable or minimally displaced. This path allows the body’s natural healing process to occur while maintaining the bone fragments in an acceptable position. Treatment often begins with closed reduction, where a doctor manipulates the bone fragments back into alignment without an incision, typically using local or regional anesthesia.
Once reduced, the limb is placed in immobilization, usually starting with a splint and later converting to a cast. The cast provides rigid external support, preventing movement while the fracture heals. Non-surgical treatment is most suitable for extra-articular fractures (not extending into the joint) that can be reduced to an acceptable and stable alignment.
Immobilization traditionally lasts between four to six weeks. Patients are encouraged to move their fingers, elbow, and shoulder to prevent stiffness in adjacent joints. Regular follow-up X-rays are scheduled, particularly within the first three weeks, to monitor the fracture fragments and ensure they have not shifted within the cast.
When Operation Becomes Necessary
An operation becomes necessary when the fracture is unstable, severely displaced, or involves the joint surface in a way that cannot be held with a cast. The goal of surgery is to restore the bone alignment and joint surface smoothness, then stabilize the fragments rigidly. The most common method is Open Reduction and Internal Fixation (ORIF), which involves making an incision to directly visualize the fracture fragments.
In ORIF, specialized plates and screws, typically made of titanium, hold the bone fragments securely in their corrected position. These implants are often placed on the volar (palm) side of the radius, providing strong, internal support. The use of a volar locking plate is common, as the screws lock into the plate, creating a fixed-angle construct that provides superior stability.
For highly comminuted fractures or those with significant soft tissue injury, other techniques may be employed:
Alternative Surgical Techniques
- External fixation involves placing pins into the bone fragments above and below the fracture, connected by a frame outside the skin. This device indirectly pulls the bones into alignment by applying tension through the surrounding ligaments (ligamentotaxis).
- Percutaneous pinning involves inserting thin metal wires (Kirschner wires or K-wires) through the skin and into the bone fragments to hold them in place.
These wires may be used alone for simpler fractures or combined with other hardware for added support.
Post-Treatment Recovery Timeline
The recovery journey begins immediately after treatment. For non-surgical treatment, the initial phase is the immobilization period, typically lasting three to six weeks. Once the cast is removed, the patient enters rehabilitation, focusing on regaining lost range of motion and improving grip strength through physical therapy. Full functional recovery often takes several months, with improvements continuing for up to a year.
Surgical treatment, especially with stable internal fixation, often allows for a shorter immobilization period, sometimes only a splint for one to two weeks. The benefit of rigid internal fixation is the ability to begin gentle, active wrist range of motion exercises sooner, minimizing joint stiffness. However, surgery does not eliminate the need for an intensive rehabilitation program to restore full function.
Regardless of the approach, achieving full strength and pre-injury function can take substantial time, often requiring at least six months and occasionally extending up to two years. Surgical patients often require intensive physical therapy to address post-operative swelling and scar tissue. Non-surgical patients must overcome the profound stiffness resulting from longer immobilization. Consistent engagement in rehabilitation is the ultimate determinant of a successful long-term result.