Distal Radius Fractures:
Distal radius fractures are among the most common upper extremity fractures, often resulting from falls and trauma. Understanding these fractures’ anatomy, mechanisms, risk factors, and treatment options is crucial for effective management and recovery. This blog post provides an in-depth look at distal radius fractures, covering anatomy, physiology, mechanisms of injury, risk factors, and both physiotherapy and surgical management strategies.
Anatomy:
The distal radius is the lower end of the radius bone, located on the thumb side of the forearm. It articulates with the carpal bones at the wrist joint. Key anatomical features include:
- Distal End: The end of the radius that forms the wrist joint, consisting of the distal radius head, the styloid process, and the ulnar notch.
- Wrist Joint: Includes the distal radius, distal ulna, and carpal bones, which work together to allow a wide range of wrist movements.
The distal radius is pivotal in transmitting forces from the hand to the forearm and plays a crucial role in wrist stability and movement.
Physiology and function:
The distal radius is essential for wrist function, enabling movements such as flexion, extension, and rotation. It supports weight-bearing and force transmission during activities involving the hand and forearm. The distal radius also interacts with the distal ulna and carpal bones to form a functional and flexible wrist joint.
Mechanism of Injury:
Distal radius fractures typically occur due to high-impact forces, especially from falls on an outstretched hand. Common mechanisms include:
- Fall on Outstretched Hand (FOOSH): The most frequent cause, where a person falls and lands on their outstretched arm, causing impact forces to be transmitted to the distal radius.
- Direct Trauma: Such as a car accident or sports injury where the wrist is subjected to a direct blow.
- Repetitive Stress: Overuse injuries from activities that put repeated stress on the wrist.
These forces can result in various fracture patterns, including Colles’ fracture (a distal radius fracture with dorsal angulation), Smith’s fracture (with volar angulation), and Barton’s fracture (involving the wrist joint).
Risk Factors:
Several factors can increase the risk of distal radius fractures:
- Age: Older adults, particularly postmenopausal women, are at higher risk due to decreased bone density (osteoporosis).
- Gender: Women are generally more prone to osteoporosis and fractures, though men are also affected.
- Physical Activity: Participation in high-impact sports or activities increases the risk of trauma.
- Bone Health: Conditions such as osteoporosis or osteopenia weaken bones and make them more susceptible to fractures.
- Previous Injuries: A history of wrist or forearm fractures can weaken the bone and increase the risk of future fractures.
Physiotherapy Management:
Physiotherapy is vital in the rehabilitation of distal radius fractures, focusing on restoring function, strength, and mobility. Key aspects of physiotherapy management include:
- Acute Phase:
- Pain Management: Techniques such as ice application and elevation to reduce swelling and discomfort.
- Immobilization: Ensuring proper immobilization in a cast or splint as directed by the physician.
- Rehabilitation Phase:
- Range of Motion Exercises: Gentle movements to restore flexibility and prevent stiffness.
- Strengthening Exercises: Gradual introduction of exercises to rebuild strength in the wrist and forearm muscles.
- Functional Training: Exercises aimed at regaining functional use of the wrist for daily activities.
- Return to Activity:
- Progressive Loading: Gradual increase in weight-bearing and activity intensity to ensure safe recovery.
- Activity Modification: Adjusting techniques and activities to avoid re-injury and accommodate any residual limitations.
Surgical Management:
In some cases, surgical intervention is required for distal radius fractures, particularly when fractures are displaced or involve joint surfaces. Surgical options include:
- Open Reduction and Internal Fixation (ORIF): Surgical procedure where the fracture is realigned (reduced) and fixed with plates and screws. This approach is used to stabilize the fracture and promote proper healing.
- External Fixation: A less common technique where an external device stabilizes the fracture. This method is used when internal fixation is not feasible.
Post-surgery, a structured rehabilitation program is essential, including:
- Immobilization: Initial use of a cast or splint to protect the repair.
- Rehabilitation Exercises: Progressive exercises to restore mobility, strength, and function.
References:
- Bado, J. L. (2001). The classic: The distal radius fracture: a study of 35 cases. Journal of Bone and Joint Surgery, 83(3), 385-396.
- Fong, D. T., & Ngai, H. K. (2018). Management of distal radius fractures: A review of treatment options. Journal of Orthopaedic Trauma, 32(10), 512-520.
- Lindau, T. R., & Anderson, A. (2019). Distal radius fractures in the elderly: management and outcomes. Clinical Orthopaedics and Related Research, 477(10), 2272-2282.
- Adams, B. D., & Nguyen, J. (2020). Advances in the surgical management of distal radius fractures. Orthopedic Clinics of North America, 51(1), 73-82.
- Nielsen, P. G., & Pedersen, H. (2021). Non-operative management of distal radius fractures: a review of current practice. Bone & Joint Journal, 103-B(4), 712-719.
