The distal radius is the most common fracture site in the upper extremity. Such injuries account for approximately one-sixth of fractures treated in United States emergency departments (EDs) . Familiarity with wrist anatomy and the natural history of major fracture types is essential for appropriate management of distal radius fractures . This topic review will discuss the evaluation and management of distal radius fractures in adults. Other wrist injuries are discussed elsewhere. (See "Evaluation of the adult with acute wrist pain" and "Overview of carpal fractures".)
EPIDEMIOLOGY AND RISK FACTORS
A review of over 1.4 million United States emergency department (ED) visits found that hand and forearm fractures account for 1.5 percent of all visits . Of these, fractures of the radius and/or ulna comprise the largest portion (44 percent).
The majority of distal radius fractures occur as isolated injuries in two distinct populations: youth involved in sport who sustain a relatively high-energy fall, and seniors with osteoporotic bone who sustain a low-energy fall.
Athletics — The mechanism for sustaining wrist fractures among young people varies according to the local popularity of different physical activities. A Scottish study of distal radius fractures related to sport found that football (ie, soccer) produced 50 percent of fractures . Play on artificial turf increased the likelihood of fracture by a factor of five. Skiing, dancing, and rugby caused 12, 9, and 7 percent of wrist fractures, respectively. More severe injuries occurred as a result of skiing, horseback riding, and dancing.
The increasingly popular sport of snowboarding has a high rate of associated extremity fractures, including those of the distal radius. Physicians at a Japanese hospital caring for more than 10 ski areas evaluated over 5000 snowboarders for injuries . They found most distal radius fractures occurred in patients in their twenties (82.3 percent) without extensive snowboarding experience (42 percent novices; 48 percent intermediates). Ninety-four percent of patients had not received professional instruction, and 87 percent were not wearing protective equipment. Although less likely to be injured, more experienced snowboarders were more likely to sustain a complex intraarticular fracture.