What is a distal radius fracture?

A distal radius fracture is a break of the radius bone close to the wrist. It is the most common adult fracture and most often follows a fall on an outstretched hand. The fracture may be a simple crack (undisplaced), an angulated 'dinner-fork' deformity (a Colles fracture), an extension into the wrist joint (intra-articular), or a complex high-energy pattern with multiple fragments.

Do I need surgery for a broken wrist?

Not every distal radius fracture needs surgery. An undisplaced or minimally displaced fracture in an older patient is often managed in a cast for 6 weeks with an excellent outcome. Surgery (open reduction and internal fixation) is considered when the fracture is significantly displaced or angulated, extends into the wrist joint with a step in the articular surface, is unstable in the cast, or involves multiple fragments — and particularly in active patients in whom restoring wrist mechanics matters.

How is the diagnosis made?

Plain wrist radiographs in two or three views are diagnostic for most fractures. CT scanning is added for fractures with intra-articular extension, multi-fragment patterns, or where surgical planning would benefit from a 3D view. DEXA scanning to assess for osteoporosis is appropriate for older patients, particularly women over 50, since a low-energy distal radius fracture is often the first fragility fracture and a marker for future fracture risk.

How long is the recovery?

Most distal radius fractures heal in 6 to 8 weeks. After surgical fixation, the wrist is splinted for 1 to 2 weeks for comfort, then mobilised with hand therapy. Light activities return within 2 to 4 weeks; driving usually at 4 to 6 weeks once the wrist is comfortable and protected; full strength and heavy manual work typically at 3 to 4 months. Functional recovery beyond 3 months continues for up to 12 months.

When is this an urgent injury?

Significant displacement, an 'open' fracture (bone visible through the skin), severe swelling with finger numbness, or signs of compartment syndrome all warrant emergency department assessment. A closed but displaced fracture is best assessed within a week — the surgical window for the cleanest fixation is approximately 2 to 3 weeks from injury.

Distal radius fracture · Diagnosis & Treatment

What it is.

A distal radius fracture is a break of the radius bone close to the wrist — the larger of the two forearm bones, on the thumb side. It is the most common adult fracture in clinical practice. The pattern most patients have heard of, the Colles fracture, is a dorsally-angulated fracture in an older patient after a fall on an outstretched hand. There are several other named patterns — the volar-tilted Smith fracture, intra-articular Barton and die-punch patterns, and the high-energy comminuted fracture in a younger patient — each of which has different implications for treatment.

How it happens.

Two distinct mechanisms account for almost every distal radius fracture:

Low-energy fall on an outstretched hand (FOOSH), usually in an older patient with osteoporotic or osteopenic bone. The bone fails at the metaphysis just above the wrist joint.
High-energy injury — motor-vehicle accident, fall from height, sporting impact — in a younger patient. These fractures are often comminuted (multi-fragment), often intra-articular, and often associated with other injuries.

A low-energy distal radius fracture in a person over 50 is, statistically, the first marker of bone fragility — and worth treating as a flag for a formal bone-health assessment (including a DEXA scan), independent of whatever is decided about the fracture itself.

How the diagnosis is made.

Plain radiographs — posteroanterior, lateral and oblique — are diagnostic for most distal radius fractures. The key radiographic measurements are radial height, radial inclination, volar tilt, and articular congruency. A CT scan is added when the fracture extends into the wrist joint, when multiple fragments are present, or when surgical planning will benefit from a three-dimensional view of the articular surface.

Examination focuses on three things: the alignment of the wrist (a visible dinner-fork deformity is a giveaway), the perfusion and sensation of the hand (a swollen carpal tunnel can compress the median nerve and warrants urgent recognition), and the integrity of the skin (an open fracture is a surgical emergency).

What the treatment depends on.

Most distal radius fractures can be safely managed without surgery if the fragments sit in a position that will heal to acceptable function. The decision turns on a combination of patient-level and fracture-level factors:

Reasons a cast alone is enough.

The fracture is undisplaced or only minimally displaced.
The patient is older, with lower demands on the wrist.
The fracture is extra-articular and stable in the cast (this needs to be confirmed on weekly radiographs through the first 2–3 weeks).
The bone quality is poor enough that fixation hardware would be unreliable.

Reasons surgery (ORIF) earns its place.

Significant displacement or angulation — particularly dorsal angulation greater than approximately 10°, loss of more than approximately 5 mm of radial height, or any volar (Smith) angulation.
Intra-articular extension with a step or gap in the articular surface (typically more than 2 mm).
Multi-fragment (comminuted) fractures that will not hold position in a cast.
Loss of reduction in the cast at the 1- or 2-week check.
Active patients — manual work, sport, dominant hand — in whom restoring wrist mechanics matters more than the trade-off of a short operation.
Open fractures — surgical emergency, washout and stabilisation in theatre.

The contemporary surgical answer is open reduction and internal fixation with a volar locking plate — a small incision on the palm side of the wrist, the fracture is reduced anatomically, and a low-profile plate-and-screws construct holds it while the bone heals. The plate is permanent and almost never removed.

What recovery looks like.

For an undisplaced fracture in a cast: typically 6 weeks of immobilisation, then 6–12 weeks of structured hand therapy to regain range and grip.

For a surgically fixed fracture: a soft splint for 1–2 weeks, then early mobilisation under hand-therapy guidance. Light activities return within 2–4 weeks; driving usually at 4–6 weeks once the wrist is comfortable and a safe emergency stop is possible; full strength and heavy manual work typically at 3–4 months. Functional recovery continues to improve for up to 12 months.

Almost every patient should see a hand therapist after a distal radius fracture — whether or not they have had surgery. Wrist mobilisation and graded strengthening recover the last 20% of function that the operation (or the cast) cannot deliver on its own.

What the score should be aiming for.

The goal of treatment — cast or surgical — is not perfect radiographs. It is a wrist that does what the patient needs it to do. A 75-year-old with low demands and a healed fracture in 15° of dorsal angulation has often had a very acceptable outcome. A 45-year-old plasterer with the same radiograph has not. The treatment decision is tuned to the patient.

Bone health afterwards.

A low-energy distal radius fracture in a patient over 50 is one of the strongest early signals of osteoporosis — and is associated with a substantially increased risk of a hip fracture in the years that follow. Every patient in this group should be offered a DEXA scan and a discussion of bone-protective treatment if indicated, separately from the management of the fracture itself. The wrist fracture is a moment that can be turned into a longer-term win.

Frequently asked questions.

Do I definitely need surgery?

Not always. Many distal radius fractures heal well in a cast. Surgery is reserved for fractures that won't hold a useful position, fractures that extend into the wrist joint with a step in the surface, or fractures in active patients in whom restoring the mechanics matters. The decision is made together at the consultation, with your imaging in front of us.

How long am I in a cast or splint?

Non-operative: a full cast for approximately 6 weeks. After ORIF: a soft splint for 1–2 weeks for comfort, then mobilisation in hand therapy — the construct is stable from day one.

Will my wrist be the same again?

Most patients regain functional motion and strength. A small loss of extreme range (the last few degrees of wrist extension or supination) is common and rarely limits daily life. Heavy overhead manual work and impact-loaded sport are the activities most likely to highlight a residual limitation.

Can I drive in a cast?

Generally not. You need both hands free, an unrestricted grip, and the ability to perform an emergency stop. Driving resumes when the cast or splint is off and your wrist is comfortable enough to grip the wheel firmly — usually 4–6 weeks.

Does the plate need to come out?

Almost never. Modern volar locking plates are low-profile and well-tolerated. Removal is occasionally considered for hardware irritation or tendon issues, but this is uncommon.

References.

Mauck BM, Swigler CW. Evidence-based review of distal radius fractures. Orthop Clin North Am. 2018;49(2):211–222.
Lichtman DM, Bindra RR, Boyer MI, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on the treatment of distal radius fractures. J Bone Joint Surg Am. 2011;93(8):775–778. (Updated 2020.)
Costa ML, Achten J, Plant C, et al. DRAFFT: a randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius. Health Technol Assess. 2015;19(17):1–124.

Distal radius fracture.