Distal radius fracture
Distal radius fracture is a break of the distal radial metaphysis, classically from a fall onto an outstretched hand, presenting with a dinner-fork or garden-spade wrist deformity and confirmed by wrist radiograph, treated with closed reduction and casting for stable patterns or surgical fixation for displaced, intra-articular, or unstable fractures.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
A fracture of the distal radial metaphysis, almost always from a fall onto an outstretched hand: distal radius fracture is the most common upper-extremity fracture and often the sentinel fragility…
- Epidemiology
The single most common upper-extremity fracture, particularly in older women.
- Risk factors
Osteoporosis and low bone mineral density: the dominant risk factor in older adults, from estrogen-depleting states, hypogonadism, uncontrolled hyperthyroidism, hyperparathyroidism, chronic inflammatory disease, or corticosteroid use.
- Pathophysiology
Axial load through a dorsiflexed wrist concentrates force at the distal radial metaphysis, the transition between dense cortex and weaker cancellous bone, which is why this site fails.
- Clinical features
Wrist pain, swelling, and inability to use the hand after a fall onto an outstretched hand should prompt radiographic evaluation.
- Differential diagnosis
Scaphoid fracture: anatomic snuffbox tenderness rather than distal radial tenderness after the same FOOSH mechanism; a thumb spica cast is placed empirically since films can be falsely negative for up to 2 weeks; see scaphoid fracture.
- Diagnosis
The diagnosis is confirmed first, at initial presentation, by wrist radiograph showing a fracture line through the distal radial metaphysis; the direction of displacement (dorsal versus volar) and…
- Management
First, assess neurovascular status, then perform closed reduction under hematoma block or procedural sedation for any displaced fracture, restoring radial length, inclination, and volar tilt before…
- Complications
Malunion: healing with residual angulation, radial shortening, or joint step-off, the most common complication, causing chronic pain, grip weakness, and limited forearm rotation.
- Prognosis
Most stable or well-reduced fractures heal well with casting over 4 to 6 weeks, with good recovery, particularly in children given their remodeling capacity.
- Prevention
Screen for osteoporosis with dual-energy x-ray absorptiometry (DEXA) bone density testing in all women 65 or older, and in younger postmenopausal women with risk factors, and in any adult who has…
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Scaphoid fracture
Scaphoid fracture follows a fall onto an outstretched hand and is suspected by anatomic snuffbox tenderness even with a normal initial radiograph; nondisplaced fractures are treated with thumb spica immobilization and displaced or unstable fractures with screw fixation.
- Extremity fractures
Extremity fractures are diagnosed by focal bony tenderness, deformity, or inability to bear weight/load confirmed on radiograph, and are triaged first for life- and limb-threatening features (hemorrhage, open injury, vascular compromise, compartment syndrome) before definitive fixation decisions. Open fractures need immediate antibiotics and operative debridement, and unstable or displaced patterns need surgical fixation, while stable nondisplaced fractures are managed with reduction and immobilization.
- Carpal tunnel syndrome and median nerve compression
Carpal tunnel syndrome is compression of the median nerve at the wrist causing pain, paresthesia, and eventually weakness in the thumb, index, middle, and radial half of the ring finger, treated first with neutral wrist splinting and, when refractory, with corticosteroid injection or surgical decompression.
- Osteoporosis
Osteoporosis is low bone strength that raises fragility fracture risk, diagnosed by a hip or spine T-score of -2.5 or less or by a fragility fracture itself. First-line treatment is an oral bisphosphonate, alendronate or risedronate, alongside adequate calcium and vitamin D intake.