Wrist fractures affecting the distal radius are the most common fracture in adults and are typically caused by a fall on the outstretched hand.
This injury may be accompanied by fractures of the ulnar styloid, the distal ulna, and the scaphoid. Isolated scaphoid fractures can also occur and should be considered in the differential of a patient with radial-sided wrist pain after a fall on their hand.
Nondisplaced fractures do not have any deformity and are treated with immobilization in a splint or cast.
Displaced fractures usually present with a "dinner fork" deformity and require closed reduction and possible surgical fixation. Successfully reduced fractures can be treated nonsurgically with immobilization and radiographic monitoring.
Malunion of inadequately reduced fractures may result in decreased range of motion and grip strength, as well as pain, in younger, patients who may place a higher demand on the wrist.
Purely ligamentous injuries can be a cause of wrist pain after a fall on an outstretched hand in the setting of normal radiographs.
Wrist fractures include fractures that affect the distal ends of the radius, ulna, and carpus. Fractures of the distal radius (DRF) are one of the most common injuries. The distal radius is defined as the distal one third of the radius. DRFs may be extra-, intra-, or partial articular and are regularly accompanied with an ulnar styloid fracture.
Fractures associated with a radiographic appearance that is essentially normal with respect to extra- and intra-articular anatomy are considered nondisplaced. All other fractures (i.e., all fractures with loss of anatomical contours) are considered to be displaced. Clearly, all displacements are not the same and some fractures are associated with greater anatomical deformity than others. Fractures associated with an open wound are considered open fractures.
History and exam
Key diagnostic factors
- history of trauma or osteoporosis
- wrist pain
- tenderness over the distal radius
Other diagnostic factors
- tenderness in the anatomic snuff-box
- numbness in the fingers
- open wound
- absent pulse
1st investigations to order
- plain radiographs of the wrist
Investigations to consider
- CT wrist
- MRI (without contrast) wrist
- dual-energy x-ray absorptiometry (DXA)
isolated fracture of distal radius
isolated scaphoid fracture
concomitant distal radius and scaphoid fractures
confirmed wrist fracture
Niels W.L. Schep, MD
Trauma, Hand and Wrist Surgeon
Department of Trauma and Hand Surgery
NWLS is an author of several references cited in this topic. He is a consultant for Synthes, Medartis, and Arthrex, and has received honoraria from The AO Foundation for teaching courses.
Dr Niels W.L. Schep would like to gratefully acknowledge Dr Jeffrey N. Lawton, Dr John R. Lien, Dr Gregory D. Byrda, Dr Tamara D. Rozental, and Dr Chaitanya S. Mudgal, previous contributors to this topic.
JNL is a consultant for Innomed Inc, has received honoraria from The AO Foundation for teaching courses, and has been sponsored for research by DePuy Synthes. JRL and GDB declare that they have no competing interests. TDR is an author of several references cited in this topic. CSM has been reimbursed by AO North America and Asia Pacific for being a faculty member during educational conferences.
Asif Ilyas, MD
Program Director of Hand and Upper Extremity Surgery
Associate Professor of Orthopaedic Surgery
Thomas Jefferson University
AI declares that he has no competing interests.
Isam Atroshi, MD, PhD
Associate Professor of Orthopaedics
Hand Surgery Section
Department of Orthopaedics
Hässleholm and Kristianstad Hospitals
- Wrist strain
- Ligamentous carpal injury
- Triangular fibrocartilage complex (TFCC) tear
- Management of distal radius fractures
- ACR appropriateness criteria: acute hand and wrist trauma
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