Distal radius fracture
Fracture of the lower end of the radius, the most common adult fracture. Usually follows a fall onto an outstretched hand. Treatment ranges from a cast to surgical fixation depending on the displacement and the patient.
📊 Distal radius fractures are the most common fractures of the upper limb, accounting for around one in six of all adult fractures. They are particularly common in postmenopausal women with osteoporosis and in young adults from high-energy injury.
What is a distal radius fracture?
The radius is one of the two long bones of the forearm; its lower end forms most of the wrist joint. When you fall and put your hand out to save yourself, much of the force goes through the lower end of the radius, and it is here that the bone breaks. The wrist becomes painful, swollen and often visibly deformed, the classic "dinner-fork" appearance described by Colles in 1814.
Not all distal radius fractures are the same. They vary enormously in their pattern, severity and stability. Some are simple, undisplaced cracks that heal perfectly in a plaster cast. Others are comminuted (broken into many pieces), involve the joint surface, or have displaced badly, these often require surgery to restore the alignment of the bone, especially the angle of the joint surface, before healing.
In older patients with osteoporosis, even a low-energy fall can cause a significant fracture. In younger patients, the fracture is usually higher energy, a fall from a height, a sporting injury, or a road traffic collision, and is often associated with other injuries that should be looked for.
Common causes
- Fall onto an outstretched hand (FOOSH), the most common cause
- Sporting injury, particularly cycling, skiing, contact sport
- High-energy trauma, road traffic collision, fall from height
- Osteoporotic fragility fracture, minimal force in older patients
- Repetitive stress fracture (rare, in athletes)
Who is at risk? Female sex and postmenopausal status, particularly with osteoporosis, are major risk factors. In younger patients, contact sport, cycling, snowboarding and skateboarding are common causes. A fragility fracture in an older patient should prompt assessment for osteoporosis.
Symptoms
Symptoms vary depending on the severity and duration of the condition. Common symptoms include:
- Pain, swelling and tenderness at the wrist after a fall
- Often visible deformity, the classic "dinner fork" shape
- Inability to move the wrist or use the hand
- Bruising and sometimes broken skin (open fracture)
- Pins and needles or numbness if the median nerve is compressed
- Difficulty straightening the fingers (median nerve involvement)
When to seek help: Any suspected fracture of the wrist needs urgent assessment in an Emergency Department for X-ray and treatment. Open wounds, severe deformity, loss of finger movement, or significant numbness are all signs that urgent treatment is needed.
How is it diagnosed?
Your hand surgeon will take a detailed history and examine the hand and wrist. The following investigations may be arranged to confirm the diagnosis:
- Plain X-rays of the wrist in two views, the cornerstone of diagnosis
- Measurement of radial height, radial inclination and volar tilt
- Assessment for intra-articular involvement
- CT scan, for complex intra-articular fractures or before surgical planning
- Examination of the median nerve, tendon function, and the vascular supply
A small subset of fractures (around 5%) develop acute carpal tunnel syndrome from swelling and bony displacement, which is a surgical emergency. Any worsening numbness or severe pain in a plastered fracture should be reviewed urgently.
Treatment pathway
Treatment is tailored to the severity of the condition, your age, activity level, and overall health. Most conditions are treated in a stepwise fashion, starting with the least invasive options.
Plaster cast immobilisation
A well-moulded plaster cast is applied for 4-6 weeks, with X-ray review at 1, 2 and 6 weeks to ensure the position is maintained. Hand and elbow exercises start immediately to prevent stiffness. Most undisplaced and minimally displaced fractures heal well with this approach.
Manipulation and cast
For displaced fractures with reasonably good bone quality, the fracture is manipulated under local or regional anaesthetic and a cast applied. X-rays at 1 and 2 weeks check that the position has been maintained. Around half of manipulated fractures slip again and require surgery.
Open reduction and plate fixation
For fractures that are significantly displaced, intra-articular, or that have slipped after manipulation, surgical fixation with a volar locking plate is the most common approach. Allows early mobilisation of the wrist and reliable maintenance of alignment. Performed as day case or short stay surgery.
K-wires or external fixator
Percutaneous K-wires are sometimes used for younger patients with extra-articular fractures. An external fixator is reserved for severely comminuted or open fractures, often as a temporary measure before definitive surgery.
Recovery
Even after a "simple" cast treatment, the wrist is usually stiff and weak for several months. Hand therapy is often valuable, especially after intra-articular fractures or surgery. Most patients are using the hand normally for light tasks by 3 months and have returned to sport and heavy work by 6 months.
- Cast or splint after surgery: 4-6 weeks
- Wrist movement begins: 6 weeks
- Light activity: 8-10 weeks
- Heavy lifting and sport: 3-6 months
What results can I expect?
Good in most cases, but outcomes are highly dependent on restoring the alignment of the joint surface. Intra-articular step-off of more than 2mm increases the risk of post-traumatic arthritis. Median nerve symptoms usually resolve, but ongoing stiffness and grip weakness can take many months to improve.
In numbers
Typical activity timelines for this condition. These are approximate and vary considerably between patients. Always follow the specific guidance given by your surgeon and hand therapist.
| Activity | Typical timeline | Notes |
|---|---|---|
| Move the fingers | Day one | Active finger movement from day one is the single most important preventable step, finger stiffness is the most common complication.[3] |
| Drive | When cast is off and safe | Most patients drive 6-8 weeks after non-operative treatment, or 4-6 weeks after surgery if grip allows. Confirm with surgeon and insurer.[4] |
| Shower | Cast / splint covered | Use a waterproof cast cover. After cast removal, washing as normal. |
| Desk work | 2-4 weeks (surgery) or 4-6 weeks (cast) | Once comfortable. Many patients work from home or one-handed earlier.[1] |
| Manual work | 2-3 months | Heavy lifting, hammering, and tool use usually waits until the bone has fully healed and strength has returned.[1] |
| Sport | 3-6 months | Non-contact sport from 3 months, contact and impact sports nearer 6 months. Wrist guards may help during initial return.[1] |
| Full strength | 6-12 months | Grip and wrist strength continue to improve gradually. Final outcome can take up to a year.[1] |
Common concerns from patients with this condition or recovering from treatment, and whether they are expected or worth mentioning to your team.
- 1.British Society for Surgery of the Hand: Distal radius fracture
- 2.NHS: Broken wrist (distal radius fracture)
- 3.British Association of Hand Therapists: Patient information leaflets
- 4.Royal College of Surgeons of England: Driving after surgery guidance
References are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.
Going to have surgery?
If your team has recommended an operation for this condition, our step-by-step prep guide covers what to expect.
Hand therapy guide
Phased exercise programme, key precautions, and what to expect from rehabilitation for this condition.
How is it diagnosed?
- ✓Plain X-rays of the wrist in two views, the cornerstone of diagnosis
- ✓Measurement of radial height, radial inclination and volar tilt
- ✓Assessment for intra-articular involvement
- ✓CT scan, for complex intra-articular fractures or before surgical planning
- ✓Examination of the median nerve, tendon function, and the vascular supply
Recovery milestones
- •Cast or splint after surgery: 4-6 weeks
- •Wrist movement begins: 6 weeks
- •Light activity: 8-10 weeks
- •Heavy lifting and sport: 3-6 months