Examine individual changes

'{{Infobox medical condition (new) | name = Distal radius fracture | synonyms = Broken wrist<ref name=AO2013>{{cite web|title=Distal Radius Fractures (Broken Wrist)-OrthoInfo - AAOS|url=http://orthoinfo.aaos.org/topic.cfm?topic=a00412|website=orthoinfo.aaos.org|accessdate=18 October 2017|date=March 2013}}</ref> | image = Collesfracture.jpg | width = | alt = | caption = A [[Colles fracture]] as seen on X-ray. It is a type of distal radius fracture. | pronounce = | field = [[Orthopedics]], [[emergency medicine]] | symptoms = Pain, bruising, and swelling of the wrist<ref name=AO2013/> | complications = | onset = Sudden<ref name=AO2013/> | duration = | types = [[Colles' fracture]], [[Smith's fracture]], [[Barton's fracture]], [[Hutchinson fracture]]<ref name=Mac2016/> | causes = Trauma<ref name=Mac2016/> | risks = [[Osteoporosis]]<ref name=AO2013/> | diagnosis = Based on symptoms, [[radiography|X-rays]]<ref name=AO2013/> | differential = | prevention = | treatment = [[orthopedic cast|Casting]], surgery<ref name=AO2013/> | medication = [[Analgesics|Pain medication]], elevation<ref name=AO2013/> | prognosis = Recovery over 1 to 2 years<ref name=AO2013/> | frequency = ~33% of broken bones<ref name=Mac2016/> | deaths = }} <!-- Definition and symptoms --> A '''distal radius fracture''', also known as '''wrist fracture''', is a [[fracture (bone)|break]] of the [[radius (bone)|radius bone]] in the forearm.<ref name=AO2013/> Symptoms include pain, bruising, and swelling of rapid onset.<ref name=AO2013/> The wrist may be deformed.<ref name=AO2013/> The [[ulna bone]] may also be broken.<ref name=AO2013/> <!-- Cause and diagnosis --> In younger people these fractures typically occur during sports or a [[motor vehicle collision]].<ref name=Mac2016/> In older people the most common cause is falling on an outstretched hand.<ref name=Mac2016/> Specific types include [[Colles' fracture|Colles]], [[Smith's fracture|Smith]], [[Barton's fracture|Barton]], and [[Hutchinson fracture]]s.<ref name=Mac2016/> The diagnosis is generally suspected based on symptoms and confirmed with [[radiography|X-rays]].<ref name=AO2013/> <!-- Treatment --> Treatment is with [[orthopedic cast|casting]] for six weeks or surgery.<ref name=AO2013/> Surgery is generally indicated if the joint surface is broken and does not line up, the radius is overly short, or the joint surface of the radius is tilted more than 10% backwards.<ref name=Al2016/> Among those who are casted repeated X-rays are recommended within three weeks to verify that a good position is maintained.<ref name=Al2016/> <!-- Epidemiology and prognosis --> Distal radius fractures are common.<ref name=Al2016>{{cite journal|last1=Alluri|first1=RK|last2=Hill|first2=JR|last3=Ghiassi|first3=A|title=Distal Radius Fractures: Approaches, Indications, and Techniques.|journal=The Journal of hand surgery|date=August 2016|volume=41|issue=8|pages=845–54|doi=10.1016/j.jhsa.2016.05.015|pmid=27342171}}</ref> They represent between 25 and 50% of broken bones.<ref name=Mac2016/> They occur most commonly in young males and older females.<ref name=Al2016/><ref name=Mac2016>{{cite journal|last1=MacIntyre|first1=NJ|last2=Dewan|first2=N|title=Epidemiology of distal radius fractures and factors predicting risk and prognosis.|journal=Journal of hand therapy : official journal of the American Society of Hand Therapists|date=2016|volume=29|issue=2|pages=136–45|doi=10.1016/j.jht.2016.03.003|pmid=27264899}}</ref> A year or two may be required for healing to occur.<ref name=AO2013/> {{TOC limit|3}} ==Signs and symptoms== [[File:Distalradiusfracture.jpg|thumb|Malreduced distal radius fracture demonstrating the deformity in the wrist]] People usually present with a history of an injury and localized [[pain]]. There is often a deformity in the wrist with associated swelling. Numbness of the hand can occur because of compression on the median nerve across the wrist ([[carpal tunnel syndrome]]). The wrist deformity often limits motion of the fingers. ===Examination=== Swelling, deformity, tenderness and loss of wrist motion are normal features on examination of a patient with a distal radius fracture. Examination should rule out a skin wound which might suggest an open fracture. It is imperative to check for loss of sensation, loss of circulation to the hand, and more proximal injuries to the forearm, elbow and shoulder. The most common associated neurological finding is decreased sensation over the [[thenar eminence]] due to associated median nerve injury. ===Injuries associated=== [[File:TFCC tear.jpg|thumb|Arthroscopic image of a central triangular fibrocartilage complex (TFCC) tear.]] The most commonly associated injury is to the [[ulnar styloid process]]. Styloid fractures can occur either to the very tip of the styloid or at the base. Because the [[triangular fibrocartilage]] (TFCC) attaches to the base of the ulna styloid, displaced fractures can result in instability of the distal radio-ulnar joint. [[Carpal bone fracture]]s such as those to the [[scaphoid]] have been described, whereas instability or dislocations of the wrist are seen with certain types of distal radius and ulna fractures. Injuries to the elbow, humerus and shoulder are also common after a fall on outstretched hand. Swelling and displacement can cause compression on the median nerve across the wrist, an acute [[carpal tunnel syndrome]]. Very rarely is pressure on the muscle components of the hand or forearm sufficient to create a [[compartment syndrome]]. ==Cause== The most common cause of this type of fracture is a fall on an outstretched hand (''[[acronym]]'': FOOSH).<ref name="pmid10499710">{{cite journal |last=Vilke |first= GM |title=FOOSH injury with snuff box tenderness |journal=J Emerg Med |volume=17 |issue=5 |pages=899–900 |year=1999 |pmid=10499710 |doi=10.1016/S0736-4679(99)00102-X}}</ref> In young adults this fracture is the result of moderate to severe force such as a fall from a significant height or a motor vehicle accident. The risk of injury is increased in patients with [[osteoporosis]] and other metabolic bone diseases. ==Diagnosis== Diagnosis may be evident clinically when the distal radius is deformed but should be confirmed by [[X-ray]]. The [[differential diagnosis]] includes [[scaphoid fracture]]s and wrist dislocations, which can also co-exist with a distal radius fracture. Occasionally, fractures may not be seen on X-rays immediately after the injury. Delayed X-rays, [[X-ray computed tomography]] (CT scan), or [[Magnetic resonance imaging]] (MRI) will confirm the diagnosis. ===Medical imaging=== X-ray of the affected wrist is required if a fracture is suspected. CT scan is often performed to investigate the articular anatomy of the fracture, especially if surgery is considered. Investigation of a potential distal radial fracture includes assessment of the angle of the joint surface on lateral X-ray, the loss of length of the radius from the collapse of the fracture, and congruency of the distal radioulnar joint. Displacement of the articular surface is the most important factor affecting prognosis and treatment. ==Classification== In medicine, classifications systems are devised to describe patterns of injury which will behave in predictable ways, to distinguish between conditions which have different outcomes or which need different treatments. Most wrist fracture systems have failed to accomplish any of these goals and there is no consensus about the most useful one. At one extreme, a stable undisplaced extra-articular fracture has an excellent prognosis. On the other hand, an unstable, displaced intra-articular fracture is difficult to treat and has a poor prognosis without operative intervention. Eponyms such as Colles', Smith's, and Barton's fractures are discouraged. ===Anatomic=== However, an anatomic description of the fracture is the easiest way to describe the fracture, decide on treatment, and make an assessment of stability. ** Articular incongruity ** Radial shortening ** Radial angulation ** [[Comminution]] of the fracture (the amount of crumbling at the fracture site) ** Open ([[compound fracture]]) or closed injury ** Associated [[ulnar styloid fracture]] ** Associated soft tissue injuries ====Articular surface==== [[File:Displaced distal radius fracture.jpg|thumb|X-ray of a displaced intra-articular distal radius fracture in an external fixator. The articular surface is widely displaced and irregular.]] The articular joint's surface must be smooth for it to function properly. Irregularity may result in radiocarpal [[arthritis]], pain, and stiffness. More than 1&nbsp;mm of incongruity places the patient at a high risk for [[post-traumatic arthritis]]. Significant articular incongruity typically occurs in young patients after high energy injuries (Figure 2). If the surface is very irregular and cannot be reconstructed, then the only option may be a fusion. ====Volar vs dorsal tilt==== [[File:Dorsal tilt of distal radius fracture.jpg|thumb|left|120px|Fracture with a dorsal tilt. Dorsal is left, and volar is right in the image.]] A [[Anatomical terms of location#Hands and feet|dorsal]] tilt of a distal radius fracture is shown in {{color|red|red}} in image at left. The angulation goes between:<ref name="Piva NetoLhamby2011">{{cite journal|last1=Piva Neto|first1=Antonio|last2=Lhamby|first2=Fabio Colla|title=Fixação das fraturas da extremidade distal do rádio pela técnica de kapandji modificada: avaliação dos resultados radiológicos|journal=Revista Brasileira de Ortopedia|volume=46|issue=4|year=2011|pages=368–373|issn=0102-3616|doi=10.1590/S0102-36162011000400004}}</ref> *A line drawn between the distal ends of the [[Radius (bone)#Structure|articular surface of the radius]] on a lateral X-ray. *A line that is [[perpendicular]] to the [[diaphysis]] of the radius. Sometimes, the diaphysis of the radius is hard to distinguish from the [[ulna]], and a line between them ({{color|turquoise|turquoise line}} in image) may be used instead.<ref>{{cite web|url=https://radiopaedia.org/articles/colles-fracture|title=Colles fracture|author= Paresh K Desai|accessdate=2016-12-18|website=[[Radiopedia]]}}</ref> The angle normally has [[Anatomical terms of location#Hands and feet|volar]] tilt of 11° to 12°. The most common fracture pattern usually demonstrates malalignment of this angle and collapse in a [[Anatomical terms of location#Hands and feet|dorsal]] direction. A dorsal tilt of 0° (11° - 12° deviation from normal anatomic position) causes a substantial risk of developing pain and impaired function.<ref name=Cooney2011>[https://books.google.com/books?id=qva8f16BewEC&pg=PA347 Page 347] in: {{cite book|title=The Wrist: Diagnosis and Operative Treatment|author=William P. Cooney|publisher=Lippincott Williams & Wilkins|year=2011|isbn=9781451148268}}</ref> After [[Reduction (orthopedic surgery)|closed reduction]], a residual dorsal tilt of a maximum of 5° (16° - 17° deviation) is regarded as the maximal residual angle for a satisfactory result.<ref name=Cooney2011/> ====Radial inclination==== [[File:Radial inclination of distal radius fracture.jpg|thumb|right|150px|Fracture with a decreased radial inclination (about 15°).]] The radial inclination of a distal radius fracture is shown in {{color|red|red}} in image at right and goes between:<ref>{{cite web|url=http://emedicine.medscape.com/article/398406-overview|title=Distal Radial Fracture Imaging|author=Jack A Porrino, Jr|date=2015-10-20|accessdate=2016-12-18|website=[[Medscape]]}}</ref><ref>{{cite journal|url=http://www.ijoonline.com/article.asp?issn=0019-5413;year=2016;volume=50;issue=6;spage=610;epage=615;aulast=Mishra|title=Morphometry of distal end radius in the Indian population: A radiological study|author1=Pankaj Kumar Mishra |author2=Manoj Nagar |author3=Suresh Chandra Gaur |author4=Anuj Gupta |year=2016|volume=50|issue=6|journal=Indian Journal of Orthopaedics}}</ref> *A line drawn between the distal ends of the [[Radius (bone)#Structure|articular surface of the radius]] on a ventro-posterior view of the wrist. *A line that is perpendicular to the diaphysis of the radius. Radial inclination is normally 21-25°.<ref>[https://books.google.com/books?id=q3_EthzU3dcC&pg=PA783 Page 783] in: {{cite book|title=Diagnostic Imaging for the Emergency Physician|authors=Joshua Broder|publisher=Elsevier Health Sciences|year=2011|isbn=9781437735871}}</ref> ====Radial length and ulnar variance==== [[File:Radial length and ulnar variance.jpg|thumb|380x380px|Positive, neutral, and negative ulnar variance. Relationship between radial length and ulnar variance. Radial length is the measure from distal ulna to radial styloid process. When ulnar variance is neutral radial length should be between 9-12mm.<ref name=":0">{{Cite book|url=https://www.worldcat.org/oclc/876669045|title=Orthopedic imaging : a practical approach|last=Adam,|first=Greenspan,|others=Beltran, Javier (Professor of radiology),|isbn=9781451191301|edition=Sixth|location=Philadelphia|oclc=876669045}}</ref>|none]] Radial length is an important consideration in distal radius fractures. Typical radial length should be between 9-12mm.<ref name=":0" /> Distal radius fractures typically result in loss of length as the radius collapses from the loading force of the injury. With increasing relative lengthening of the uninjured ulna (positive ulnar variance), [[ulnar impaction syndrome]] may occur. Ulnar impaction syndrome is a painful condition of excessive contact and wear between the ulna and the carpus with an associated is a degenerative tear of the TFCC. <ref>{{cite book|last1=Ricci|first1=editors, Robert W. Bucholz ... [et al.] ; associate editors, Margaret M. McQueen, William M.|title=Rockwood and Green's fractures in adults.|date=2009|publisher=Lippincott Williams & Wilkins|location=Philadelphia, Pa.|isbn=978-1605476773|edition=7th ed.}}</ref>===Melone classification=== The system that comes closest to directing treatment has been devised by Melone. This system breaks distal radius fractures down into 4 components: '''radial styloid''', '''dorsal medial fragment''', '''volar medial fragment''', and '''radial shaft'''. The two medial fragments (which together create the lunate fossa) are grouped together as the '''medial complex'''. * Type I - No displacement of medial complex without comminution. Fracture is stable after closed reduction. * Type II - Unstable "die-punch" - Moderate/severe medial complex displacement. Comminution of dorsal and volar cortices. ** Type IIA - Irreducible, closed fracture. ** Type IIB - Irreducible, closed due to impaction * Type III - Type II fracture with a 'spike' of the radius volarly (may impinge on median nerve) * Type IV - Split fracture (unstable) - severe comminution, rotation of fragments. * Type V - Explosion injuries - Severe displacement/comminution, often associated with diaphyseal comminution as well. ===Melone classification=== The system that comes closest to directing treatment has been devised by Melone. This system breaks distal radius fractures down into 4 components: '''radial styloid''', '''dorsal medial fragment''', '''volar medial fragment''', and '''radial shaft'''. The two medial fragments (which together create the lunate fossa) are grouped together as the '''medial complex'''. * Type I - No displacement of medial complex without comminution. Fracture is stable after closed reduction. * Type II - Unstable "die-punch" - Moderate/severe medial complex displacement. Comminution of dorsal and volar cortices. ** Type IIA - Irreducible, closed fracture. ** Type IIB - Irreducible, closed due to impaction * Type III - Type II fracture with a 'spike' of the radius volarly (may impinge on median nerve) * Type IV - Split fracture (unstable) - severe comminution, rotation of fragments. * Type V - Explosion injuries - Severe displacement/comminution, often associated with diaphyseal comminution as well.<ref>{{cite book|last1=Ricci|first1=editors, Robert W. Bucholz ... [et al.] ; associate editors, Margaret M. McQueen, William M.|title=Rockwood and Green's fractures in adults.|date=2009|publisher=Lippincott Williams & Wilkins|location=Philadelphia, Pa.|isbn=978-1605476773|edition=7th ed.}}</ref> ===Universal classification=== The Universal classification system is descriptive but also does not direct treatment. Universal codes are:<ref>[https://books.google.com/books?id=yujV5S_TP_UC&pg=PA182 Page 182] in: {{cite book|title=Orthopedic Secrets|authors=David E. Brown, Randall D. Neumann|publisher=Elsevier Health Sciences|year=2004|isbn=9781560535416}}</ref> ** Type I: extra-articular, undisplaced ** Type II: extra-articular, displaced ** Type III intra-articular, undisplaced ** Type IVa: intra-articular, displaced, stable, reducible ** Type IVb: intra-articular, displaced, unstable, reducible ** Type IVc: intra-articular, displaced, unstable, irreducible ==Treatment== [[File:Posttraumatic arthritis of the wrist.jpg|thumb|Posttraumatic arthritis of the wrist. Degeneration of the articular surface before and after resection.]] [[File:Wrist fusion.jpg|thumb|rays of a wrist fusion.]] [[File:Pins across a distal radius fracture.jpg|thumb|X-rays of pins across a distal radius fracture. Notice the ulnar styloid base fracture, which has not been fixed. This patient has instability of the DRUJ because the TFCC is not in continuity with the ulna.]] The type of treatment required depends on many factors, including displacement and stability of the fracture fragments. Open fractures require debridement, irrigation, and antibiotics.<ref name=":1">{{Cite book|url=https://www.worldcat.org/oclc/706805938|title=Essentials of musculoskeletal care|date=2010|publisher=American Academy of Orthopaedic Surgeons|others=Sarwark, John F.|isbn=9780892035793|location=Rosemont, Ill.|oclc=706805938}}</ref> ===Non-operative=== Where the fracture is undisplaced and stable, non operative treatment involves immobilization. Initially a sugar tong splint is applied to allow swelling and subsequently a cast is applied.<ref name=":1" /> Depending on the nature of the fracture, the cast may be placed above the elbow to control forearm rotation. For [[torus fracture]]s a splint may be sufficient and casting may be avoided.<ref>{{cite web|url=http://www.bestbets.org/bets/bet.php?id=1009|title=BestBets: Is a cast as useful as a splint in the treatment of a distal radius fracture in a child|work=|format=|accessdate=}}</ref> In displaced fractures, the fracture may be manipulated under anaesthesia and splinted in a position to minimize the risk of re-displacement. Typically, this involves injecting local anesthesia into the fracture (hematoma block) possibly combined with intravenous medication.<ref>{{Cite book|url=https://www.worldcat.org/oclc/960851324|title=Handbook of fractures|last=1967-|first=Egol, Kenneth A.,|date=2015|publisher=Wolters Kluwer Health|others=Koval, Kenneth J., Zuckerman, Joseph D. (Joseph David), 1952-, Ovid Technologies, Inc.|isbn=9781451193626|edition=5th|location=Philadelphia|oclc=960851324}}</ref> A manual reduction is performed to reposition the displaced distal radius into its preinjury position and maintain this position in a well formed splint or cast. During the period of follow-up, it is common practice to repeat x-rays at about 1 week to make sure the position is still acceptable. Further followup is needed to determine when the fracture has healed and when rehabilitation is complete. The critical time during the period of attempted treatment with casting is the first 3 weeks. The swelling will reduce during this time and the fracture can displace. If the displacement becomes unacceptable, closed treatment may need to be abandoned and surgery pursued. More than 3 weeks after injury, the fracture will start to heal and further displacement becomes less likely. The length of time in the cast varies with different ages. Children heal more rapidly, but may ignore activity restrictions. Three weeks in a cast and 6 weeks off sports may be appropriate for certain fractures. In adults, the risk of stiffness of the joint increases the longer it is immobilized. If callus is seen on x-ray at 4 weeks, the cast may be replaced by a removable splint. However, many hand surgeons leave the patients in the cast for up to 6 weeks. In general, the x-rays will not show any callus until about a month after the fracture is healed; therefore the cast is removed before the x-rays confirm that it is healed. Displaced fractures in the elderly or those physiologically unable to undergo surgery are treated differently. When the fracture is displaced and there are no plans for a surgery, a short arm cast is placed for only 4 weeks or until the tenderness resolves. A larger cast placed for an extended period of time only slows down recovery in this group of patients. Following healing and cast removal a period of rehabilitation for recovery of strength and range of motion is necessary. Patients will continue to improve after the fracture for 4 to 12 months. ===Reduction=== Closed management of a distal radius fracture involves first [[anesthesia|anesthetizing]] the affected area with a [[hematoma block]], regional anesthesia, [[sedation]] or a general anesthetic. Manipulation generally includes first placing the [[arm]] under traction and unlocking the fragments. The deformity is then reduced with appropriate closed manipulations (depending on the type of deformity) [[reduction (orthopedic surgery)|reduction]], after which a splint or cast is placed and an [[X-ray]] is taken to ensure that the [[reduction (orthopedic surgery)|reduction]] was successful. The cast is usually maintained for about 6 weeks. Closed treatment is frequently unsuccessful in maintaining a good position in adults, because there is frequently [[comminution]] of the fracture. Re-displacement and deformity can reoccur with an unacceptable ultimate result. ===Risks of non-operative treatment=== Failure of non-operative treatment is common and is the largest risk of an adverse outcome. Studies have shown that the fracture often re-displaces to its original position even in a cast.<ref>{{cite journal |last1=Abbaszadegan |first1= H |last2= von Sivers |first2= K |last3= Jonsson |first3= U |title=Late displacement of Colles' fractures |journal=Int Orthop |volume=12 |issue=3 |pages=197–9 |year=1988 |pmid=3182123 |doi=10.1007/BF00547163}}</ref> Only 27% - 32% of fractures are in acceptable alignment 5 weeks after closed reduction.<ref>{{cite journal |last1=Earnshaw |first1= SA |last2= Aladin |first2= A |last3= Surendran |first3= S |last4= Moran |first4= CG |title=Closed reduction of colles fractures: Comparison of manual manipulation and finger-trap traction: a prospective, randomized study |journal=J Bone Joint Surg Am |volume=84-A |issue=3 |pages=354–8 |date=March 2002 |pmid=11886903}}</ref> In the long term this increases the risk of [[Joint stiffness|stiffness]] and post traumatic [[osteoarthritis]] leading to wrist pain and loss of function. It is because of these findings that many surgeons recommend operative intervention if the fracture is displaced enough to consider a reduction. Ultimately, the fractures that have a closed reduction may return to the position before the reduction is attempted. Stiffness of the wrist is universal following a fracture of the distal radius. The degree of stiffness in the wrist is dependent on the type of fracture and the period of immobilization. It is for this reason that an open reduction is advantageous. It is also quite common for patients to develop digital stiffness after a fracture of the distal radius. Aggressive movement of the fingers while immobilized or following operative treatment is stressed to minimize digital stiffness. Other risks specific to cast treatment relate to the potential for compression of the swollen arm causing [[carpal tunnel syndrome]] or [[compartment syndrome]]. Carpal tunnel syndrome may be related to the position of the wrist (i.e. excessive flexion) or excess distraction if the wrist is placed in an external fixator. Compartment syndrome is swelling in the muscle compartments, usually in the forearm, leading to severe pain, loss of nerve function and a contracture. Finally, [[complex regional pain syndrome]] (reflex sympathetic dystrophy) is a serious complication following injury and is thought to be more common after cast immobilization than after surgery. The provoking factors for regional pain syndromes, however, are very complex but the condition often leads to chronic pain and stiffness. ===Prognosis following non-operative treatment=== In children the outcome of distal radius fracture treatment in casts is usually very successful with healing and return to normal function expected. Some residual deformity is common but this often remodels as the child grows. In the elderly, distal radius fractures heal and may result in adequate function following non-operative treatment. A large proportion of these fractures occur in elderly people that may have less requirement for strenuous use of their wrists. Some of these patients tolerate severe deformities and minor loss of wrist motion very well even without reduction of the fracture. In this low demand group only a short period of immobilization is indicated as rapid mobilization improves functional outcome. In younger patients the injury requires greater force and results in more displacement particularly to the articular surface. Unless an accurate reduction of the joint surface is obtained, these patients are very likely to have long term symptoms of [[pain]], [[arthritis]], and stiffness. ===Surgery=== Contemporary surgical options have improved treatment of this injury. Techniques include [[Internal fixation|Open Reduction Internal Fixation]] (ORIF), [[external fixation]], [[percutaneous pinning]], or some combination of the above. Significant advances have been made in operative open reduction and internal fixation. Two newer treatment are fragment specific fixation and fixed angle volar plating. These attempt fixation rigid enough to allow almost immediate mobility, in an effort to minimize stiffness and improve ultimate function, although there has been no demonstration of improved final outcome from early mobilization (prior to 6 weeks after surgical fixation). Although restoration of radiocarpal alignment is thought to be of obvious importance the exact amount of angulation, shortening, intra articular gap/step which impact final function are not exactly known. The alignment of the distal radioulnar joint is also important as this can be a source of a pain and loss of rotation after final healing and maximum recovery. Prognosis varies depending on dozens of variables. If the [[anatomy]] (bony alignment) is not properly restored, function may remain poor even after healing. Restoration of bony alignment is not a guarantee of success, as there are significant soft tissue contributions to the healing process. An [[Arthroscopy|arthroscope]] can be used at the time of fixation to evaluate for soft tissue injury. Structures at risk include the triangular fibrocartilage complex and the scapholunate ligament. Scapholunate injuries in radial styloid fractures where the fracture line exits distally at the scapholunate interval should be considered. TFCC injuries causing obvious DRUJ instability can be addressed at the time of fixation. ==Prognosis== [[Nonunion]] is rare; almost all of these fractures heal. However, if the fracture is unstable the deformity at the fracture site will increase and cause limitation of wrist motion and forearm rotation, [[pronation]] and [[supination]]. If the joint surface is damaged and heals with more than 1–2&nbsp;mm of unevenness, the wrist joint will be prone to post-traumatic [[osteoarthritis]] (Figures 4 and 5). Displaced fractures of the ulnar styloid base associated with a distal radius fracture result in instability of the distal radioulnar joint and resulting loss of [[forearm]] rotation (Figure 6). ==Epidemiology== Distal fracture of the radius is the most commonly occurring fracture in adults. It is common in the elderly because of the frequent osteopenia and osteoporosis in this age group. This is also a common injury in children which may involve the [[epiphysis|growth plate]]. A similar fracture in children involving the growth plate is called a [[Salter-Harris fractures|Salter-Harris fracture]]. In young adults, the injury is often very severe because it requires greater force to produce the injury. ==References== {{reflist}} ==External links== {{Medical resources | ICD10 = {{ICD10|S|52|5}} | AO = 21-A1 - 21-C3 | MeSH1 = S52.5 }} * [https://web.archive.org/web/20050130204453/http://www.ota.org/compendium/radius.pdf Orthopaedic Trauma Association Fracture Classification] Radius and Ulna * [http://www.wheelessonline.com/ortho/fractures_of_the_radius Wheeless' Textbook of Orthopaedics] Fractures of the Radius {{Fractures}} {{DEFAULTSORT:Distal Radius Fracture}} [[Category:Bone fractures]] [[Category:RTT]]'