What is a distal radius fracture?
A distal radius fracture is a type of wrist fracture. The radius is one of the bones that form the wrist joint (Figure 1). The radius may be fractured or “broken” as a result of a fall or other forms of trauma. This is one of the most common injuries treated by a hand surgeon. There are many varieties of distal radius fractures and the most appropriate treatment depends on the type of fracture as well as the individual patient.
How is a distal radius fracture treated?
There are many forms of treatment for these injuries. However, the most common treatment methods are cast immobilization or open reduction internal fixation meaning to fix the fracture with a plate and screws.
Surgery is usually recommended if the bones are badly out of place. Cast treatment is used for minor fractures where the bones are broken but have not separated. Cast treatment is also appropriate for patients who are not healthy enough to undergo surgery or who do not wish to undergo surgery. When a cast is used to treat a distal radius fracture it typically remains on for six weeks.
How is surgery performed?
This is an outpatient surgery. Patients typically spend a few hours in the hospital and return home the same day. The surgery is performed either with general anesthesia or with a “block” in which the arm is numbed.
An approximately three-inch incison is made on the forearm. The position of the bones is corrected and a plate and screws is used to hold the bones in place. The plates are made from stainless steel or titanium. They are very thin and usually can not be felt by the patient. In the rare situation where the plate is irritating it can be removed in the future after the break has healed.
What should I expect after surgery?
The day of surgery
If a block has been used your hand will be numb following surgery. The block can last for several hours and sometimes into the next day. The first indication that the block is wearing off is that your fingers will start to tingle. At this point you should begin taking your pain medications. If the block has not worn off by the time you go to sleep you should also begin your pain medication.
After the surgery you will have a splint on your wrist and your arm will be in a sling. The splint will remain on until your office appointment and it should not get wet or dirty. The sling must be worn until the block wears off and after that you may wear it as needed for comfort.
During the first 48 hours following surgery you should try to keep the arm elevated above chest level. This will help to prevent swelling in the fingers.
The first two weeks
During this time you will be wearing your post-operative splint. You should keep this splint clean and dry. When showering please cover with a water-tight plastic bag. You may begin moving your fingers immediately after surgery, and should work on trying to make a full fist. This will help prevent stiffness. You should not attempt to lift anything with the hand at this point.
Two weeks – Six weeks
At your two-week office appointment your splint and stitches will be removed. At this point, you will be given a removable splint. You do not have to wear this splint, but many patients feels they need some support at this stage. If you choose to wear the splint you should remove it occasionally during the day to perform gentle motion and for bathing. You may gradually increase your use of the hand for daily activity such as typing, writing, eating, picking up light objects, etc. During this time your use of pain medication will gradually decrease.
After Six weeks
At this point you will no longer need to use the splint. The fracture is not fully healed yet but is beginning to strengthen. You can lift light objects (less than five pounds) and may perform activities that are not painful.
Will I need physical therapy?
Many patients require physical therapy to maximize their recovery. Your doctor will decide if physical therapy is right for you.
What medications will I be taking?
A narcotic pain medication such as Vicodin or Percocet will be prescribed for after your surgery. These medications are usually needed for up to six weeks after the operation.
A stool softener is recommended when you are taking narcotic pain medications. This is because the narcotics can be very constipating. Many stool softeners can be purchased as over the counter medications. One such medication is Colace, another is Miralax.
Vitamin C. Your doctor may suggest that you take Vitamin C to maximize healing. If so, you should take 500 milligrams twice per day for two months. There have been some research studies that suggest Vitamin C may decrease pain during the healing phase. Other studies have shown no benefit to taking Vitamin C, but even if it doesn’t help there is little harm in a little extra Vitamin C.