One of the most common – and painful — forearm fractures I see is the distal radius fracture. The radius is the larger of the two bones of the forearm. The end toward the wrist is called the distal end – hence the term, distal radius fracture.
When it comes to frequency, the radius is the arm bone folks are most likely to break. In our office, we see radius fractures in a variety of situations: if a fall causes you to land on your outstretched hands, if you are in a car or bicycle accident, a fall from a horse – the list is more like a scroll that rolls to the ground and then some.
If you’ve ever broken a wrist, you will know there is immediate pain and swelling. The wrist may be in an odd position, the visual of which doesn’t help alleviate any of the concern. Distal radius fractures may or may not extend into the joint. (If it involves the joint, it is called an intra-articular fracture. If not, it is referred to as an extra-articular fracture.)
The damage done varies from minor to fairly severe: sometimes the broken bone breaks the skin (open fracture), or the bone breaks into more than two pieces (comminuted fracture). Intra-artciular fractures, open fractures, and comminuted fractures usually require surgical treatment, followed by several weeks of hand therapy.
If surgical treatment is not required, splinting for a few days is common, until the swelling goes down, and the patient can apply ice intermittently. A plaster cast may then be applied after about a week, then changed two or three weeks later as the swelling continues to decrease. (If you ever wonder why a cast gets so loose towards the end – swelling has gone down that much.) This cast is usually removed six weeks post injury, and hand therapy is begun to help improve function of the injured wrist.
More severe breaks are treated by surgery, which can usually be done as an outpatient. The patient is placed under general anesthesia, and the bone is repaired with plates and screws (and metal detectors will become your best friend). After surgery, the patient is sent home in a removable splint. Occasionally, after surgery to repair a badly fractured distal radius, complex regional pain syndrome (CRPS) can occur. Be warned – initially the surgery is painful. We try to numb the affected area for about 24 hours after surgery, and then after that the patient will probably feel some discomfort for a few days.
Though a fracture typically takes six weeks to heal and three to six months to completely recover, most of my patients can start working on the range of motion of the hand, wrist, elbow and shoulder in hand therapy within a week or two of surgery. And most people – except those with very complex fractures — are back to normal activity, including vigorous physical activity within three months.
– Dr. Ostrowski