Distal radius fractures are extremely common, accounting for approximately 1/10 of all fractures in daily life. They are frequently seen in elderly women, children, and young adults. The fracture occurs within 2-3 cm of the distal radius and is often accompanied by damage to the radiocarpal joint and the distal radioulnar joint.

bubble_chart Etiology

1. Extension Fracture (Colles Fracture)

The most common type, usually caused by indirect violence. It was described in detail by A. Colles in 1814. It occurs when falling with the wrist joint in dorsiflexion and the forearm in pronation, with the palm striking the ground, concentrating the force on the cancellous bone of the distal radius, resulting in a fracture. The distal fragment displaces dorsally and radially. In children, it may present as an epiphyseal separation; in elderly individuals with osteoporosis, even minor trauma can cause a fracture, often comminuted, with shortening due to impaction. Comminuted fractures may involve the articular surface or be accompanied by an avulsion fracture of the ulnar styloid and dislocation of the distal radioulnar joint.

2. Flexion Fracture (Smith Fracture)

Less common, first described by R.W. Smith in 1874. The mechanism of injury is opposite to that of the extension fracture, hence also called a reverse Colles fracture. It occurs when falling with the back of the hand striking the ground, causing the distal fragment to displace volarly and ulnarly.

3. Barton Fracture

Refers to a longitudinal oblique fracture of the distal radial articular surface, accompanied by wrist joint dislocation. It was first described by J.R. Barton in 1838. Falling with the palm or back of the hand striking the ground transmits force upward, causing an impact through the proximal carpal bones, leading to a fracture of the radial articular surface. A fracture fragment containing articular cartilage forms on the volar or dorsal side of the distal radius, often displacing proximally, with associated wrist joint dislocation or subluxation.

Wrist swelling and tenderness are evident, with limited movement of the hand and wrist. Extension-type fractures present with the typical dinner fork and bayonet deformities, the radial and ulnar styloid processes are at the same level, and the straight-edge test is positive. Flexion-type fractures show deformities opposite to those of extension-type fractures. Pay attention to possible median nerve injury.

bubble_chart Auxiliary Examination

X-rays can clearly show the fracture and its type. In extension-type fractures, the distal end of the radius is displaced dorsally and radially, with the palmar and ulnar inclination angles of the articular surface reduced, lost, or even reversed. The distal fracture end of the radius is impacted into the proximal end, and some cases may be accompanied by a fracture of the ulnar styloid process and separation of the distal radioulnar joint. In flexion-type fractures, the distal end of the radius is displaced volarly. For elderly patients injured by minor trauma, a bone density test should be performed to assess the degree of osteoporosis.

bubble_chart Diagnosis

Severe pain in the wrist after trauma, with reluctance to move. X-rays can confirm the location of the fracture and the degree of displacement.

bubble_chart Treatment Measures

1. Non-displaced fracture

can be treated with a four-tailed gypsum bandage or small splint to immobilize the wrist in a functional position for 3 to 4 weeks.

2. Displaced extension-type fracture or flexion-type fracture

can often be successfully reduced manually. For extension-type fractures that are non-comminuted and do not involve the joint surface, the traction-shaking reduction method is commonly used. For elderly patients, comminuted fractures, or those involving the joint surface, the lift-press reduction method is often employed. After reduction, the wrist is maintained in palmar flexion and ulnar deviation, fixed with gypsum or an external fixation frame for 4 weeks. For flexion-type fractures, the reduction direction is antagonistic after longitudinal traction, and the wrist is fixed in dorsiflexion and pronation for 4 weeks. After fixation, an X-ray should be taken immediately to check alignment. Another X-ray should be taken about a week later after swelling subsides. If re-displacement occurs, prompt intervention is required.

that is difficult to reduce or maintain (such as a Barton fracture) often requires surgical reduction with Kirschner wires, screws, or T-plate internal fixation. Postoperatively, gypsum fixation is applied for 6 weeks.

4. Management of complications

For malunion of fractures that impair function, surgical correction of the deformity and internal fixation are necessary. If distal radioulnar joint dislocation affects forearm rotation, the ulnar head may be excised. For median nerve injury, if no recovery is observed after 3 months, nerve exploration and decompression should be performed, and any protruding bone ends should be smoothed. Delayed rupture of the extensor pollicis tendon requires removal of osteophytes and tendon repair. Osteoporosis should be treated accordingly to prevent other severe fractures (such as femoral neck fracture) and complications.

5. Functional exercise

During fracture immobilization, attention should be paid to exercising the shoulder, elbow, and fingers. Particularly in elderly patients, shoulder stiffness should be prevented.

bubble_chart Complications

median nerve injury; delayed rupture of extensor pollicis tendon; femoral neck fracture