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Distal Radius Fractures

(Wrist Fractures; Colles Fractures; Smith Fractures)

By Danielle Campagne, MD , Assistant Clinical Professor, Department of Emergency Medicine, University of San Francisco - Fresno

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Distal radius fractures usually result from a fall on an outstretched hand.

Most distal radius fractures are dorsally displaced or angulated (sometimes called Colles fractures); they are common, particularly among the elderly. Often, the ulnar styloid process is also fractured. Less often, volar displacement (called Smith fracture) occurs because the wrist was flexed during the injury.

Symptoms and Signs

A wrist fracture (Colles or Smith) can cause deformity or swelling, which can injure the median nerve; when the median nerve is injured, the tip of the index finger is numb and the pinch of the thumb to the little finger is weak.

Other complications (eg, stiffness, permanent deformity, pain, osteoarthritis, complex regional pain syndromes) can occur, particularly if the fracture extends into or causes displacement or angulation of the wrist joint.

Diagnosis

  • Anteroposterior and lateral x-rays

Clinical manifestations may include dorsal angulation or displacement of the distal radius (silver fork or dinner fork deformity) in addition to pain, swelling, and tenderness.

Distal radius fractures are usually visible on anteroposterior and lateral x-rays. Occasionally, CT is necessary to identify intra-articular fractures.

Treatment

  • Closed reduction

  • If the fracture is open or if reduction is unsuccessful, open reduction

  • Volar splint

  • Orthopedic follow-up within 1 wk

The joint is reduced and immobilized at 15 to 30° of wrist extension with a volar splint or sugar tong splint. Closed reduction is usually possible. During closed reduction, pain can be managed in the emergency department with opioid analgesia or a hematoma block.

Volar splint.

Sugar tong splint.

Open reduction with internal fixation (ORIF) may be necessary in the following cases:

  • The joint is disrupted.

  • The fracture resulted in excessive impaction (shortening).

  • Closed reduction was unsuccessful.

Finger traps can be used to help with closed reduction of the distal radius. They are used to hold the digits in traction while the radius (if angulated) is reduced. Traction helps distract the distal fragment to lengthen the radius.

Key Points

  • Most distal radius fractures are dorsally displaced or angulated (sometimes called Colles fractures); they are common, particularly among the elderly.

  • Wrist fractures can cause deformity or swelling, which can injure the median nerve.

  • Take anteroposterior and lateral x-rays, which usually show distal radius fractures, if present; however, occasionally, CT is needed to identify intra-articular fractures.

  • Try closed reduction followed by splinting, but if closed reduction is unsuccessful or if the joint is disrupted or excessively shortened, consider ORIF.

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