Distal Radius Fracture
The distal radius fracture (broken wrist, DRF) is the most common fracture that people suffer from. Alongside the impairment of wrist function, this type of fracture can also lead to permanent functional impairment of the hand. The prevalence of radius fracture increases with age due to the increased likelihood of osteoporosis.
In previous years, this type of fracture was subject to conservative treatment using immobilisation with a plaster cast. However, the results of this type of treatment were often unsatisfactory. Nowadays, the gold standard of treatment for radius fractures is fixation with an angle-locking plate.
Examination and Diagnosis
Patients usually arrive following a fall on their wrist. A radius fracture is suspected when there is swelling and pain. If there is externally visible malpositioning of the wrist, a fracture can be considered confirmed. The differential diagnosis process should focus on the possibility of an injury to the scapholunate ligament (SL). The initial examination should determine if there is evidence of sensitivity disorders in the medial nerve innervation area since post-traumatic acute carpal tunnel syndrome is not uncommon.
Imaging diagnostics should begin with an x-ray of the affected wrist in the dorsopalmar and lateral projections. In the event of an intra-articular radius fracture and suspected accompanying fracture of the carpal bone, a computed tomography (CT) scan of the sagittal and coronary plane should be taken to plan therapy. Attention must be paid to possible supplementary injuries in the region of the carpal bone or carpal ligaments, as damage to these structures can have a permanent negative effect on the final outcome of the treatment.
The decision of whether or not to proceed with conservative or surgical therapy should not be based on the x-ray following repositioning of the fracture, but rather on the images taken directly after the accident. In cases of dislocation of the joint surface with an angle below 10 degrees and a shortening of the radius by less than 2 mm, conservative treatment with a lower arm plaster case or thermoplastic splint immobilisation for 4 to 5 weeks can be used. After this period, physiotherapy of the hand can begin.
Radial fractures with a malpositon of more than 20 degrees, fractures with palmar angulation, and all joint fractures with “step-offs” measuring more than 2 mm, should undergo surgical treatment.
Palmar fixed-angle plate osteosynthesis is the primary technique of choice for the operative treatment of most types of fracture. During the operation, following a skin incision on the flexor side of the radius, repositioning of the fracture and plate fixation of the fractured segments of the radius takes place. In some cases, operative access via the extensor side of the radius may also be necessary. If appropriate, joint fractures can also be treated using an arthroscopy-assisted procedure.
The operation is generally carried out on an inpatient basis with a stay of between 2 to 4 days. The procedure can be carried out using either general anaesthesia or plexus anaesthesia of the arm.
After surgery, the patient is fitted with a palmar immobilisation splint. Finger movement exercises begin the day after the operation. Immobilisation will last 2 weeks for fractures without joint involvement and 4 weeks for joint fractures. However, hand therapy with the splint taken off can begin after 2 weeks. The suture material is removed after 12-14 days.
Hand function impairment following a distal radius fracture is not uncommon and therefore early hand therapy is recommended. These types of measures, coupled with good postoperative pain therapy and prophylactic measures to reduce swelling, i.e., using a raised position and cooling, can minimise the risk of developing a complex regional pain syndrome (CRPS).