Diseases

Introduction

Fracture of the distal end of the radius is the most common injury around the wrist. It is also the most common fracture seen in the upper limb. There is a bimodal distribution of such fracture, with the first peak in young individuals sustaining high-energy injuries like road traffic accidents or falling from height. The second peak is in elderly osteoporotic patients with low-energy injuries like level ground fall.

Anatomy

There are two bones in the forearm, namely radius and ulna. The wrist is a structure connecting the forearm and the hand. Injuries around the wrist can adversely affect the proper functioning of the hand.

Symptoms

There will be pain, swelling and deformity over the wrist area. Movement of fingers can be limited. If the energy of trauma is high, swelling can be severe, with associated numbness of fingers. In open fracture, bony fragments may pierce through the skin.

Diagnosis

Diagnosis is mainly by x-ray of the injured wrist. Sometimes supplementary CT scan or MRI is needed to better delineate the fracture pattern or to look for associated soft tissue injuries, which can affect the way the fracture is treated.

Treatment

To determine the best treatment for each patient, the following factors need to be considered:

1. Injury factor
   1. Closed or open fracture
   2. Displacement and stability of fracture
   3. Involvement of joint surfaces
   4. Other associated injuries
2. Patient factor
   1. Age
   2. Hand dominance
   3. Functional demand
      1. Occupation
      2. Leisure activities
   4. General health

The primary goal of treatment is to put (reduce) the fracture fragments back into appropriate alignment and let them heal in that position. Ways of achieving that include:

1. Non-surgical treatment
   1. Splinting
   2. Casting
2. Surgical treatment
   1. Pinning and casting
   2. External fixation by dedicated external fixator
   3. Internal fixation by plates and screws

Rehabilitation

Rehabilitation for such injuries should start immediately afterwards. Finger swelling control and mobilisation is important, otherwise stiffness can develop, which can adversely affect hand function. Similarly, elbow and shoulder mobilisation should start early. 

Outcome

The fracture will typically unite in around 2 months. Splints, casts or external fixator can usually be removed in around 6 weeks after the injury. Internal fixation devices like plates and screws usually do not require removal. Several months is usually needed for maximal recovery from such injury.

The Hong Kong Society for Surgery of the Hand