Distal Radial (Wrist) Fracture

Distal radial fractures are the most common fractures of the upper extremity in adults, accounting for a sixth of all fractures in A&E. There is typically a history of a fall or similar trauma where the person falls on an outstretched arm. Pain, swelling, bruising and deformity of the wrist or forearm is common.

The forearm is made of the radius and ulnar, the former beings the larger of the two. The end of the radius articulates with the lunate and scaphoid bone of the wrist to form the radiocarpal joint. The radius bone is the most commonly broken bone in the arm.

There are typically 3 types of wrist fracture:

• Colles Fracture – Usually as a result of a fall on an outstretched hand, responsible for 90% of distal radial fractures. This fracture results in posterior displacement of the fractured radius

• Smith’s Fracture - Usually as a result of falling on a flexed wrist with the palm turned upwards, result in anterior displacement of the fractured radius.

• Barton’s Fracture – This is a fracture with movement or dislocation of the carpus bones.

People who have a suspected wrist fracture usually report:

• A traumatic onset 

• Pain

• Swelling or deformity

• Reduced range of movement

• Possible altered sensation

People with a suspected wrist fracture should be examined for:

• Wrist and finger range of movement

• Grip and forearm strength

• Bony and soft tissue abnormalities

• Skin integrity

• Neural involvement

It is worth nothing that obvious wrist fractures are usually seen within A&E first, and following up in physiotherapy once able to start range of movement type exercises.

Depending on the severity of the fracture, the fracture may be treated conservatively (relocated and then maintained in a plaster cast which is then removed after 6 weeks) or surgically (where surgical wires / pinning is used to maintain the position of the wrist). Once mobility of the wrist can begin, physiotherapy can help by providing interventions such as:

• Advice and education

• Oedema and swelling management

• Pain management

• Maintenance of strength and range of movement of the wrist of the arm whilst in a cast

• Desensitisation techniques of there is a neural involvement

• Graded range of movement exercises

• Massage and mobilisation

• Progressive return to ADL’s / sport

• Electrotherapy