Distal Radius Fracture

A distal radius fracture is a break of the radius — the thicker of the two forearm bones — just above the wrist. It is the most common fracture seen in orthopedic practice, and the mechanism is almost always the same: a fall in which the person instinctively puts out a hand to catch themselves, driving the wrist backward and concentrating the force at the weakest point of the bone. When the broken end tips backward, the wrist takes on a characteristic bent-back profile known as a Colles’ fracture; the less common Smith’s fracture tips the opposite way.

What looks like a single injury is actually a spectrum. A minimally displaced break in an older patient with thinning bone behaves very differently from a shattered intra-articular fracture in a younger patient after a fall from height. Treatment depends on where the bone has broken, how far out of position it sits, whether the joint surface has been disrupted, and the demands the patient places on the wrist — which is why two people with similar-looking X-rays may be offered different plans.

After the fall, your wrist hurts immediately and swells fast. You may see an obvious bend or step-off in the wrist's profile — the classic "dinner fork" deformity where the back of the wrist juts up. Moving the wrist or gripping anything is extremely painful, and the area is tender to touch along the thumb side of the forearm just above the wrist.

Numbness or tingling in your thumb, index, and middle fingers can develop if swelling presses on the median nerve at the wrist. Bruising spreads from the wrist into the hand and up the forearm over the first few days. If the opposite side of the wrist (pinky side) also hurts, that raises the question of an associated ligament or cartilage injury on that side.

Standard front and side wrist X-rays diagnose the fracture and tell your surgeon how it's displaced — the angle of the bone, whether it's shortened, and whether the break extends into the joint surface. A CT scan is added for complex breaks that extend into the joint, to plan the fixation. Pain on the pinky-side of the wrist or any sense of looseness raises the question of an associated injury to the small ligaments and cartilage on that side (a TFCC tear or scapholunate injury).

Surgery is recommended when the alignment isn't acceptable, when the fracture won't hold position in a cast, when the joint surface has a step bigger than 2 mm, or when an active patient needs the bone healed in its proper anatomic position to maintain wrist function.

External patient-education references and related OSI pages for additional background:

• Britannica — Bone disease (fractures)
• Britannica — Hand (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language