Many distal radius fractures heal in a cast, but some - particularly displaced or unstable fractures - benefit from surgical fixation with a plate and screws. This guide covers what to expect from operative treatment.
For displaced fractures, surgery is often arranged within 1-2 weeks of injury. Pre-assessment may be done at the same visit, or shortly before surgery.
The team will check you are fit for anaesthesia, review any other injuries, and confirm the plan for surgery.
Routine pre-operative checks before general or regional anaesthesia.
Blood thinners often need temporary adjustment. Diabetic medications may need to be modified on the morning of surgery.
Options usually include regional nerve block (brachial plexus block) with sedation, or general anaesthesia. The block provides excellent pain relief for 12-18 hours.
Early movement of the fingers is essential to prevent stiffness. A hand therapy plan is arranged.
Smoking significantly impairs bone healing and increases complication risk. Stopping before surgery - even briefly - helps recovery.
You will be given a specific arrival time. Have no food from 2am on the day of surgery; you may drink clear water until 6am, unless your team gives you different instructions. Bring your medication list and any documents from the hospital.
You will be admitted to the day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
You will meet the anaesthetist. Many hand procedures are done under local or regional anaesthetic; some require general anaesthesia.
After surgery you will spend time in the recovery area where nurses monitor your vital signs until you are stable and comfortable.
Arrange for a family member or friend to collect you. You must not drive on the day of surgery if you have had a general anaesthetic or sedation.
Important: Watch for signs of complex regional pain syndrome (CRPS) - disproportionate pain, swelling, stiffness, or skin colour and temperature changes. Report these early. Median nerve symptoms (tingling in the thumb, index and middle fingers) that persist or worsen also need urgent review.
Avoid getting the wound wet until it is fully healed - usually 10-14 days. Use a waterproof cover when showering. Follow the dressing instructions you are given.
Keep the hand raised above the level of your heart as much as possible for the first 48-72 hours. This significantly reduces swelling, pain, and stiffness.
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, and ibuprofen if appropriate for you) is more effective than waiting.
Unless told otherwise, gently bend and straighten all fingers regularly. Early movement helps prevent stiffness and reduces swelling.
Seek urgent advice if you develop spreading redness, increasing pain, swelling, discharge from the wound, a temperature above 38°C, or any new numbness - these may indicate infection or nerve problems.
Recovery timelines vary between patients and depend on the operation, the demands you place on the hand, and any other health conditions. The timeline below is a general guide - your surgical and hand therapy team will give you personal advice.
A plate and screws are applied through a small incision on the front (palmar side) of the wrist. The operation takes about an hour.
Most patients go home the same day in a removable splint with the fingers free.
Active finger and shoulder movement begins immediately. Wound check and follow-up are arranged at around 2 weeks.
Wrist movement begins under the guidance of a hand therapist. The splint is gradually weaned off.
Most patients regain useful function by 3 months. Stiffness, residual ache and weakness can persist for many months and improve with continued exercise.
A removable splint is usually worn rather than a full cast, allowing finger movement and wound checks. Some surgeons use a cast for a short period; this varies with the fracture and the surgeon.
Most patients return to driving at 6-10 weeks, once the wrist is strong enough and the splint is no longer required. Check with your insurer before driving.
Plates and screws are usually left in permanently. Removal is only considered if they cause irritation - this is uncommon.
Desk-based work is usually possible at 2-4 weeks. Manual work typically requires 2-4 months off, and heavy manual work may take longer.
A week-by-week guide to recovery. Individual timelines vary, so always follow the advice of your surgical and hand therapy team.
The aim of surgery is to restore the normal alignment of the broken wrist and hold it securely, usually with a metal plate and screws, so that it heals in a good position and movement can begin early. This reduces the chance of the wrist healing crooked (malunion) with lasting deformity or weakness.
The operation is done under regional or general anaesthetic. Most commonly a plate is applied to the front (volar) surface of the radius through an incision at the wrist crease (open reduction and internal fixation). Depending on the fracture pattern, wires (K-wires) or an external frame may be used instead. The fragments are realigned and held while the bone heals.
Many wrist fractures heal well in a cast, particularly stable fractures and those in older or lower-demand patients. The wrist is checked on X-ray to make sure it stays in a good position.
Wires passed through the skin, or a frame outside the arm, are alternatives to a plate for certain fracture patterns.
Acceptable only for an undisplaced, stable fracture. A displaced fracture left untreated may heal crooked, leaving deformity, stiffness, and reduced strength.
Tendons that run over the plate can become irritated or, occasionally, rupture, which may need the plate removing or a tendon repair.
Swelling can press on the median nerve, causing carpal tunnel symptoms. Rarely this needs a release.
The fracture can heal slightly out of position or, rarely, fail to unite, which can affect movement and strength.
The plate or screws can be felt or cause irritation and are sometimes removed once the bone has healed.
A reaction causing prolonged pain, swelling, and stiffness of the hand and wrist. Early movement and hand therapy reduce the risk.
Stiffness of the wrist and fingers is common and improves with hand therapy. Moving the fingers fully from day one is important.
Swelling of the hand and fingers is expected. Keeping the hand elevated reduces it.
The scar can be tender and a small area near it numb for some weeks.
Many distal radius fractures heal well in a plaster cast, and for older or lower-demand patients the evidence shows the final function is often similar whether or not surgery is done. Surgery is mainly recommended when the fracture is displaced or unstable, because such fractures can heal crooked in a cast, leaving deformity, weakness, and reduced movement. The right choice depends on the fracture pattern, your hand use, and your general health, and your surgeon will discuss this with you.