Distal radius and ulna fracture

Disease Description (Causes and Symptoms)

• Definition: A distal radius and ulna fracture is a fracture occurring in the wrist area (the distal portions of the radius and ulna), in which the bones crack or become fragmented due to trauma.
• Causes and pathophysiology: It occurs when a person falls onto an outstretched hand or experiences high-energy trauma (such as skiing, snowboarding, or inline skating). It also commonly occurs after low-energy trauma in postmenopausal women with osteoporosis. Depending on the location of the fracture and whether the joint is involved, joint-surface instability, joint-surface depression, or fragmentation may occur, which can lead to impaired joint function or arthritis.
• Main symptoms: Severe wrist pain, swelling, bruising (hemorrhagic ecchymosis), visible deformity (displacement/deformity of the radius), tingling in the fingers or fingertips (in cases of nerve injury or compression), and limited or weakened finger movement. Additional symptoms may occur if there is an open fracture or accompanying nerve or vascular injury.

Treatment Methods and Precautions

• Diagnostic summary: Diagnosis is primarily made with plain radiographs (X-rays), and CT is used for additional evaluation of intra-articular involvement or complex fractures.
• Conservative treatment:
  • Reduction (if necessary), followed by a plaster splint or cast immobilization (usually 4–6 weeks, with the duration varying according to the fracture pattern). Initially, a splint is used to control swelling, followed by cast application.
  • Pain control: acetaminophen or NSAIDs; short-term opioid prescription may be possible in severe cases.
  • Active movement of the fingers and arm, within the range possible even while in the cast, to prevent joint stiffness.
  • If osteoporosis is suspected, bone mineral density testing and concurrent osteoporosis treatment are recommended.
• Surgical treatment:
  • Performed for fractures that cannot be reduced, intra-articular or comminuted fractures, and unstable fractures.
  • Representative methods include open reduction and plate fixation of the radius (e.g., volar locking plate), K-wire fixation, and external fixation.
  • Open fractures require surgical cleansing, fixation, and antibiotic treatment. Tetanus prevention should be considered.
• Rehabilitation:
  • After cast removal, active physical therapy (range-of-motion exercises, strengthening, and training in activities of daily living).
• Precautions and complications:
  • Complications: malunion (incomplete healing), nonunion, arthritis (when the joint surface is involved), chronic pain/CRPS (complex regional pain syndrome), wrist stiffness and movement impairment, displacement of the ulnar head, nerve injury (central nerve/median nerve), tendon rupture (e.g., EPL), and infection (after an open fracture or surgery).
  • Self-care precautions: Stop smoking (to prevent delayed bone union), receive osteoporosis treatment and adequate nutrition (calcium and vitamin D), continue finger exercises during the cast/splint period, and avoid excessive loading until the instructed period has passed.
• Prognosis: Functional recovery is generally possible with appropriate reduction and fixation, followed by rehabilitation. Involvement of the joint surface, advanced age, osteoporosis, and severe comminuted fractures are associated with a poorer prognosis, and arthritis or functional limitations may remain.

Outpatient Visit Checklist (Preparations and Sample Questions)

• Recommended items to bring:
  • A list of currently used medications (including anticoagulants and antiplatelet agents) and information about allergies, especially drug or metal allergies
  • The timing and circumstances of the trauma (when and how the injury occurred)
  • Previous imaging (initial X-rays and, if available, images taken before/after treatment) or hospital records
  • Usual medical conditions (such as osteoporosis, diabetes, or blood disorders) and surgical history
  • Occupation (frequency of wrist use) and primary mode of transportation (whether you drive)
  • Tetanus vaccination status (if an open fracture is suspected)
• Record of symptom changes to check during the outpatient visit:
  • Pain intensity and changes in pain, whether tingling or sensory impairment has developed, changes in finger movement, and whether there is a wound (open wound)
• Sample questions (questions for the patient/caregiver to write down in advance):
  • “Does my fracture extend into the joint?”
  • “Why is surgery recommended, and what are the alternatives?”
  • “How long is recovery expected to take, and when can I return to daily activities?”

Examples of General Questions to Ask the Doctor

• What treatment options can I choose for this fracture? What are the advantages and disadvantages of each method?
• If surgery is necessary, what surgical method will be used, and what are the main risks (infection, nerve injury, abnormal union, etc.)?
• When should rehabilitation and physical therapy begin, and how often should I receive them?
• When can I return to daily activities (driving, returning to work, and exercise)?
• Do I need osteoporosis testing or preventive treatment? If so, what tests do you recommend?

Examples of Disease-Specific Questions

• Does my fracture involve the joint surface (intra-articular fracture)? If there is intra-articular involvement, what is the risk of arthritis and how can it be prevented?
• Based on the current fracture pattern, is it likely to heal stably with conservative treatment alone (cast/splint), or is surgical fixation recommended?