DISTAL RADIUS FRACTURE

QUESTIONS AND ANSWERS

What is an Open Fracture?

An open fracture, also known as a compound fracture, occurs when a broken bone pierces through the skin. This type of injury is more severe than its closed counterpart, as it exposes the bone and the underlining tissue to the environment, increasing the risk of infection.

Key Characteristics of an Open Fracture:

• Bone Visibility: The fractured bone is visible through a wound.
• Surrounding Damage: Significant damage appears possible not only to the bone but also to nearby muscles, nerves, and blood vessels.
• Increased Risk of Infection: Since the bone and tissues are exposed, there is a greater potential for bacterial contamination.

Treatment Considerations:

• Immediate Medical Attention: Swift medical intervention is crucial to reduce infection risk.
• Cleaning the Wound: Thorough cleansing of the area is essential to remove debris and bacteria.
• Stabilization: Doctors must realign and stabilize a broken bone.
• Antibiotics: Administering antibiotics helps combat potential infections from the wound.

In summary, an open fracture is a serious condition that demands urgent care to prevent complications and promote healing. Proper medical treatment ensures optimal recovery.

Types of Distal Radius Fractures

Medical literature has described more than fifteen different classification structures for distal radius fractures over the last seventy years. A research study concluded that none of these classification methods help surgeons determine how to treat their patients.

A fracture occurs often in certain patterns. Some of the more prevalent varieties include the following:

Colles fracture:

The most typical distal radius fracture refers to the Colles fracture. This fracture occurs about 1.5 inches from the wrist joint.

Chauffeur’s fracture:

The radial styloid, the outside portion of the radius closest to the thumb, refers to where Chauffeur’s fracture takes place.

Die-punch fracture:

The lunate fossa, a dip at the end of the radius where it attaches to a bone in the wrist known as the lunate, refers to where a die-punch fracture occurs.

Galeazzi fracture-dislocation:

A break towards the end of the radius combined with a dislocation of the distal radioulnar joint refers to a Galeazzi fracture-dislocation. This often happens when the ulnar end shifts in front of the radius.

Barton’s fracture:

Rim fractures, or fractures that damage the radius’s outer borders, include Barton’s fracture. With this fracture, doctors normally see a dislocated wrist bone.

Greenstick and torus fractures:

These fractures refer to partial fractures and affect kids. Despite bending, the radius remains intact.

Salter-Harris type fracture:

In youngsters, a break in the growth plate refers to a Salter-Harris type fracture. The region of the bone where the bone develops refers to the growth plate.

Understanding Comminuted Fractures

A comminuted fracture occurs when a bone breaks into three or more fragments. This type of fracture is often the result of a high-impact trauma, such as a car accident or a severe fall. The shattered pieces make it a complex injury, as the fragments can complicate the healing process.

Key Characteristics

• Multiple Fragments: Unlike simpler fractures, a comminuted fracture leaves the bone in several pieces.
• High-Impact Cause: Often seen in events with significant force, contributing to the bone’s shattering.
• Complex Recovery: The multiple fragments may require surgical intervention to properly align and heal.

Treatment Options

Managing a comminuted fracture usually involves:

• Surgical Intervention: Using metal rods, pins, or plates to stabilize and align the bone pieces.
• Immobilization: Often requires the use of a cast or brace to keep the bone steady during recovery.
• Rehabilitation: Physical therapy may help restore function and strength once healing progresses.

Understanding the complexity of comminuted fractures can guide appropriate medical care and improve recovery outcomes.

What is an Extra-Articular Fracture?

An extra-articular fracture occurs when a bone break does not extend into the nearby joint. This type of fracture is significant because it affects only the bone itself, maintaining the integrity of the joint structures.

Key Characteristics:

• Location: The fracture is located outside the joint capsule, meaning it does not disturb or penetrate the joint surface.
• Common Sites: While these fractures can occur in various bones, they are often seen in areas like the wrist, where maintaining joint mobility is crucial.
• Treatment Considerations: Because the joint is unaffected, treatment often focuses on stabilizing the fracture itself, rather than addressing joint function.

Understanding this type of fracture is important for determining the appropriate treatment and rehabilitation process, ensuring both the bone and joint continue to function properly.

Understanding Intra-articular Fractures

An intra-articular fracture is a specific type of bone break that occurs when the fracture line extends into the joint space itself. This not only disrupts the continuity of the bone but also affects the joint’s surface. Such fractures are particularly significant because they can compromise joint function, leading to potential long-term issues like arthritis or chronic pain if not treated properly.

Key Characteristics:

• Location: This fracture involves both the bone and the joint, making it more complex than fractures that occur outside of the joint cavity.
• Complications: Since the joint surface is involved, precise alignment during treatment is crucial to restore normal joint function and prevent stiffness or decreased range of motion.

Why It Matters:

Understanding an intra-articular fracture’s implication is essential for both patients and healthcare providers. This type of injury often requires more detailed imaging, such as CT scans, to understand the extent of damage. Furthermore, treatment might involve surgical intervention to ensure proper joint alignment and healing.

By paying close attention to treatment protocols, healthcare providers can help preserve joint integrity and enhance recovery outcomes.

Symptoms of a Distal Radius Fracture

The most obvious symptom of a distal radius fracture is immediate pain and tenderness in the wrist. Parents may also see large swellings and bruises. In some cases, the wrist can become deformed, bent, or twisted in strange positions. If the injury isn’t too painful and the wrist isn’t flexed or bent, parents can wait until the next day to see a doctor.

How are Distal Radius Fractures Identified by Doctors?

Parents should immediately take their child to the emergency room to begin the diagnostic procedure if they believe their child has a distal radius fracture. Also, an ordinary X-ray is typically sufficient for diagnosing a distal radius fracture. In complicated situations, such as when there are several fractures or several joints affected, the doctor could prescribe a CT scan. If an orthopedic expert believes your child has a ligament injury, they may subsequently request an MRI. Injuries to soft tissues, such as ligaments, occur in 31% of distal radius fractures.

Nonsurgical Treatment

Application of a cast or splint is necessary if the distal radius fracture is in a favorable location. In many cases, it acts as a last resort up until the bone heals. For up to six weeks, a cast is worn. Then, for your child’s comfort and support, a detachable wrist splint will help. To recover appropriate wrist function and strength, children should begin physical therapy as soon as the cast is taken off. If the fracture appears unstable, the doctor will order X-rays at three weeks and again at six weeks. If the fracture was considered stable, x-rays would occur less often.

The first step is to fix a fracture that is not aligned. A local anesthetic is frequently used by the doctor to prevent pain.

After it has been properly adjusted and aligned, a plaster cast or splint is put on. If a child can wear a cast to heal a broken bone without surgery, your orthopedic surgeon will make that determination.

Understanding Closed Reduction

In cases where broken bones are nonaligned, doctors will need to realigh the fragments. This is where closed reduction comes into play. It involves moving the broken bone pieces into place and straightening the bone without opening the skin.

Post-Alignment Care

• Initial Splinting: After aligning the bones, a splint is usually applied first to accommodate any initial swelling. This temporary measure ensures comfort and stability.
• Transition to a Cast: Once the swelling subsides, typically after a few days, a cast is placed to maintain proper alignment as the bone heals.
• Adjustments Over Time: As the swelling decreases, doctors will recommend replacing the cast by one that is snug and effective in aiding healing. 

This meticulous process ensures that the fracture heals correctly, minimizing complications and promoting a return to normal function.

Surgery for Distal Radius Fractures

This approach is typically used for fractures that are deemed unstable and the doctor cannot treat the child with just a cast. Surgery is normally carried out through an incision across the volar portion of the wrist (where you feel your pulse). This gives complete access to the break. With the aid of one or more plates and screws, the parts are fitted together and secured. In some circumstances, a second incision on the back of the wrist is necessary to restore the anatomy. The components get secured in place by plates and screws.

However, if there are many bone fragments, fixation with plates and screws may not occur. To stabilize the fracture in these situations, an external fixator with or without extra wires provides the solution. Most of the hardware on an external fixator is kept outside of the body. In cases where the fracture is completely displaced and a cast will not aid in healing, surgery becomes essential. The open reduction technique involves directly accessing and aligning the broken bones through an incision. After alignment, there are various methods to secure the bones in the correct position:

• Cast: Often used when the fracture is aligned sufficiently without the need for surgical hardware.
• Plate and Screws: Ideal for fitting and securing parts together, especially in less complex cases.
• Metal Pins (Titanium or Stainless Steel): Used for additional support and stability.
• External Fixation: A stabilizing frame outside the skin holds the bones in their aligned position until healing is complete.

By combining these techniques, surgeons can adapt to the specific needs of each fracture, ensuring the best possible outcome for bone healing and functionality.

Appliances to aid healing

For two weeks following the procedure, your child will wear a splint. The doctor will replace the original wrist splint at the next appointment. Then for four weeks, your child will wear it. After a month, our child will begin physical therapy to help rebuild wrist strength and function. Your child can discontinue using the detachable splint six weeks following the procedure. Your child should continue the exercises that your doctor and therapist have recommended. For optimum post-operative recovery, early mobility is essential.

When treating distal radius fractures, a temporary external fixator plays a crucial role in managing complex injuries. Its primary purpose is to stabilize the fracture and protect the surrounding soft tissues, especially when they are severely damaged.
In the immediate aftermath of the injury, this device helps maintain the correct alignment of the bones, keeping them in place to facilitate healing. By externally supporting the broken bones, the fixator ensures that there’s minimal movement at the fracture site, reducing pain and preventing further damage.

Moreover, using a temporary external fixator allows healthcare providers to carefully manage soft tissue injuries. It provides a critical time window for the swelling to subside and the tissues to recover before a more permanent solution, like internal screws or plates, is introduced in subsequent procedures. This strategic approach not only aids in bone healing but also minimizes the risk of complications such as infection or improper healing.

Understanding Open Reduction in Distal Radius Fracture Surgery

The open reduction technique in surgical treatment is a go-to approach for managing completely displaced distal radius fractures that can’t be treated with a cast. This method involves a precise surgical procedure where the surgeon directly accesses the fracture site through an incision. The goal is to realign the fractured bones to their natural position.

Securing the Fracture: Options and Techniques

Once the bones are perfectly aligned, doctors need to hold them in place to ensure proper healing. Doctors can secure the broken bones by using several fixation methods:

• Casts: Often used for additional stability post-alignment.
• Plates and Screws: These are affixed to the bone to hold fragments in place.
• Metal Pins: Titanium or stainless steel pins provide direct stabilization.
• External Fixation Devices: A stabilizing frame positioned outside the skin keeps the bones aligned during the healing process.

Each option or combination is chosen based on the specific fracture characteristics and patient needs to ensure optimal recovery.

How Are Open Fractures Treated to Prevent Infection?

Treating open fractures requires prompt and meticulous care to minimize the risk of infection. When such an injury occurs, it’s critical to act quickly. Here’s how:

• Immediate Surgical Intervention: Surgery is generally needed within a few hours following the injury. This minimizes the window for potential bacterial contamination.
• Thorough Cleaning: Surgeons meticulously clean the exposed bone and surrounding soft tissues. This step is crucial to remove any debris and bacteria present at the site.
• Antibiotic Administration: Before surgical procedures, antibiotics are administered to further guard against infection. This medical intervention helps to bolster the body’s defenses against potential pathogens.
• Stabilization Techniques:

Initially, doctors may use temporary measures like an external fixator if the soft tissue damage is severe. This external device helps stabilize the bone while allowing soft tissues to heal.  For less severe cases, or once the area has sufficiently healed, internal fixation using screws or plates is performed. This process involves securing the fractured bones to ensure proper alignment and stability. By following these meticulous steps, healthcare professionals aim to effectively treat open fractures while preventing infection, ensuring the best possible outcome for recovery.

Complications

Most fractures are moderately painful for days to weeks. Therefore, many patients find that the use of ice, elevation (holding the arm above the heart), and over-the-counter pain relievers help reduce pain. If the pain appears severe, your doctor may prescribe stronger pain medicine. Then parents should speak with their surgeon if their child’s pain does not go away after a few days following surgery.

After surgery and casting, patients should regain full finger movement as soon as possible. If the child cannot fully move his or her finger within 24 hours because of pain or swelling, see a doctor. In some cases, the doctor may recommend working with a physical therapist to regain a full range of motion. In addition, complex regional pain syndrome (also known as reflex sympathetic dystrophy) may cause excruciating pain, which requires prompt medical intervention such as medication or nerve blocks. If your child experiences significant pain that does not subside after taking medicine, let your doctor know.

What Are Recovery and Rehabilitation?

Depending on the severity of the damage, fractures might cause pain for a few days or weeks. As mentioned previously, typically, over-the-counter painkillers do control pain. Applying cold packs and raising the hand over the heart can both relieve discomfort. Even after treatment, almost all patients still have some wrist stiffness and pain. Also, about a month or two after the cast is removed, this normally goes away. A small amount of residual stiffness may linger for up to two years or perhaps permanently in cases of severe trauma, such as that brought on by a motorbike accident. Furthermore, complete recovery from a distal radius fracture usually takes a year.

When should I seek out an orthopedic surgeon’s assistance? We at Medical City Children’s Orthopedics and Spine Specialists are aware that accidents do happen. However, this does not imply that they must prevent you from leading an active and healthy lifestyle. Finally, we are committed to getting children back to their active lifestyle as quickly as possible, whether they fish, sail, hunt, surf, or play sports. We are experts in treating a “Distal radius fracture” with state-of-the-art equipment and knowledgeable surgeons striving for your child’s well-being.

Do you Want Your Child to See the Very Best?

Finally, do you require an orthopedic expert for your child? To discuss your choices, make an appointment with one of our specialists at the Medical City Children’s Orthopedics and Spine Specialists.  Our doctors participated in specialized training in fracture and trauma care for children. We have offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX. For a wide variety of severe injuries, Medical City Children’s Orthopedics and Spine Specialists offer thorough diagnosis, treatment, and care. Please,  get in touch with us right away for treatment of a Distal Radius Fracture.

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American Academy of Orthopaedic Surgeons:  Distal Radius Fracture