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Wrist / Distral Radius Fractures

Who does it affect?
Distal radial fractures can occur in any patient, but tend to be more common in those patients over the age of 50 and, in particular, those patients with osteoporosis.

Investigations
X-Rays will often show the fracture pattern. Occasionally, fractures are investigated with CT scans.

Non-operative treatment
Only undisplaced simple fractures of the distal radius are treated non-operatively, in a plaster; usually in place for 4 - 6 weeks.

Operative treatment
There is a significant trend towards early operative fixation of distal radial fractures. This is particularly common in unstable fractures, occurring in osteoporotic patients. In the past distal radial fractures were manipulated and placed in a plaster of Paris, and held either by just the plaster of Paris or wire fixation. However, due to the poor quality of bone, the wire was often cut out, and patients were left with a recurrent deformity and significant problems.

Over the last 10 years there has been development of special surgical plates, which allow the fracture to be fixed in an extremely stable configuration, even in the presence of thin, poor quality bone. Having performed this operative fixation, with a scar usually through the front of the wrist, but occasionally on the back, patients are mobilised within the first week of surgery.

Post-operative rehabilitation
Patients who have had surgery using a modern generation plate are often allowed to mobilise within the first week of surgery. Range of movement rapidly recurs over the first 4 - 6 weeks, before strengthening exercises.

Return to activities of daily living

A plaster of Paris causes significant functional problems for the first 6 weeks, and then post-fracture stiffness can again occur for the next 6 – 8 weeks. However, early operative intervention allows for rapid return to activities of daily living, including driving and return to work.

Complications

Distal radial fractures occur into the joint, with a step, and can pre-dispose to osteoarthritis. Distal radial fractures can cause ruptures of the tendons, particularly on the back of a hand. This would cause an inability to fully straighten the fingers. Surgery has its own specific risks. These include infection and hardware problems. However, the more your surgeon performs this type of operation hopefully the lower the specific complication rate becomes.

Mr Sameer Singh's specialist areas