A distal radius fracture is a break of the radius near the wrist, usually from a fall on an outstretched hand. It is common in children and in older adults with osteoporosis, and the classic Colles fracture tilts the wrist backward.
Key symptoms
- Wrist pain after a fall on an outstretched hand
- Swelling and bruising
- Deformity, like a dinner fork in a Colles fracture
- Trouble moving the wrist; tingling in the fingers
What you find on exam
- Tenderness over the distal radius
- Median nerve check: feeling in the thumb, index and middle fingers
- Radial pulse and capillary refill
- Snuffbox tenderness for a scaphoid fracture; check the elbow and shoulder
Tests
- Wrist X-ray, front and side views
- CT if the fracture enters the joint
- Bone density test in older adults after a low-energy fracture
Treatment basics
- Splint, ice, elevation and pain control
- Closed reduction with a hematoma block if displaced, then a cast
- Surgery with plate fixation for unstable or joint fractures
- Hand therapy for motion; treat osteoporosis
Red flags
- Numbness in the median nerve area or rising pain
- Open fracture
- Cool, pale hand or slow capillary refill
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.