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Distal radius fractures in adults

David J Petron, MD
Section Editors
Patrice Eiff, MD
Chad A Asplund, MD, FACSM, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM


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) [1]. Familiarity with wrist anatomy and the natural history of major fracture types is essential for appropriate management of distal radius fractures [2]. 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".)


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 [1]. 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 [3]. 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 [4]. They found most distal radius fractures occurred in patients in their 20s (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.

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Literature review current through: Nov 2017. | This topic last updated: Nov 14, 2016.
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  1. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am 2001; 26:908.
  2. Eiff MP, Hatch RL, Calmbach WL. Carpal fractures. In: Fracture Management for Primary Care, 2nd ed, Saunders, Philadelphia 2003.
  3. Lawson GM, Hajducka C, McQueen MM. Sports fractures of the distal radius--epidemiology and outcome. Injury 1995; 26:33.
  4. Matsumoto K, Sumi H, Sumi Y, Shimizu K. Wrist fractures from snowboarding: a prospective study for 3 seasons from 1998 to 2001. Clin J Sport Med 2004; 14:64.
  5. O'Neill TW, Cooper C, Finn JD, et al. Incidence of distal forearm fracture in British men and women. Osteoporos Int 2001; 12:555.
  6. Vogt MT, Cauley JA, Tomaino MM, et al. Distal radius fractures in older women: a 10-year follow-up study of descriptive characteristics and risk factors. The study of osteoporotic fractures. J Am Geriatr Soc 2002; 50:97.
  7. Haentjens P, Johnell O, Kanis JA, et al. Evidence from data searches and life-table analyses for gender-related differences in absolute risk of hip fracture after Colles' or spine fracture: Colles' fracture as an early and sensitive marker of skeletal fragility in white men. J Bone Miner Res 2004; 19:1933.
  8. Rozental TD, Branas CC, Bozentka DJ, Beredjiklian PK. Survival among elderly patients after fractures of the distal radius. J Hand Surg Am 2002; 27:948.
  9. Khan SA, de Geus C, Holroyd B, Russell AS. Osteoporosis follow-up after wrist fractures following minor trauma. Arch Intern Med 2001; 161:1309.
  10. Gutow AP. Avoidance and treatment of complications of distal radius fractures. Hand Clin 2005; 21:295.
  11. Andersen DJ, Blair WF, Steyers CM Jr, et al. Classification of distal radius fractures: an analysis of interobserver reliability and intraobserver reproducibility. J Hand Surg Am 1996; 21:574.
  12. Bozentka DJ, Beredjiklian PK, Westawski D, Steinberg DR. Digital radiographs in the assessment of distal radius fracture parameters. Clin Orthop Relat Res 2002; :409.
  13. Medoff RJ. Essential radiographic evaluation for distal radius fractures. Hand Clin 2005; 21:279.
  14. Louis DS. Barton's and Smith's fractures. Hand Clin 1988; 4:399.
  15. Mehara AK, Rastogi S, Bhan S, Dave PK. Classification and treatment of volar Barton fractures. Injury 1993; 24:55.
  16. May MM, Lawton JN, Blazar PE. Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability. J Hand Surg Am 2002; 27:965.
  17. Lindau T. Treatment of injuries to the ulnar side of the wrist occurring with distal radial fractures. Hand Clin 2005; 21:417.
  18. Trumble TE, Benirschke SK, Vedder NB. Ipsilateral fractures of the scaphoid and radius. J Hand Surg Am 1993; 18:8.
  19. Stoffelen D, De Mulder K, Broos P. The clinical importance of carpal instabilities following distal radial fractures. J Hand Surg Br 1998; 23:512.
  20. Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury 1989; 20:208.
  21. Altissimi M, Mancini GB, Azzarà A, Ciaffoloni E. Early and late displacement of fractures of the distal radius. The prediction of instability. Int Orthop 1994; 18:61.
  22. Adolphson P, Abbaszadegan H, Jonsson U. Computer-assisted prediction of the instability of Colles' fractures. Int Orthop 1993; 17:13.
  23. MacKenney PJ, McQueen MM, Elton R. Prediction of instability of fractures of the distal radius. Presented at the Orthopedic Trauma Association, Session I, Charlotte, NC, October 22, 1999.
  24. Jeong GK, Kaplan FT, Liporace F, et al. An evaluation of two scoring systems to predict instability in fractures of the distal radius. J Trauma 2004; 57:1043.
  25. Nesbitt KS, Failla JM, Les C. Assessment of instability factors in adult distal radius fractures. J Hand Surg Am 2004; 29:1128.
  26. Roth KM, Blazar PE, Earp BE, et al. Incidence of displacement after nondisplaced distal radial fractures in adults. J Bone Joint Surg Am 2013; 95:1398.
  27. Gottlieb M, Cosby K. Ultrasound-guided hematoma block for distal radial and ulnar fractures. J Emerg Med 2015; 48:310.
  28. Fathi M, Moezzi M, Abbasi S, et al. Ultrasound-guided hematoma block in distal radial fracture reduction: a randomised clinical trial. Emerg Med J 2015; 32:474.
  29. Earnshaw SA, Aladin A, Surendran S, Moran CG. Closed reduction of colles fractures: comparison of manual manipulation and finger-trap traction: a prospective, randomized study. J Bone Joint Surg Am 2002; 84-A:354.
  30. Chamley J. The Closed Treatment of Common Fractures, Williams & Wilkins, Baltimore 1961.
  31. Fernandez DL. Closed manipulation and casting of distal radius fractures. Hand Clin 2005; 21:307.
  32. Handoll HH, Madhok R. Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev 2003; :CD000314.
  33. O'Connor D, Mullett H, Doyle M, et al. Minimally displaced Colles' fractures: a prospective randomized trial of treatment with a wrist splint or a plaster cast. J Hand Surg Br 2003; 28:50.
  34. Maciel JS, Taylor NF, McIlveen C. A randomised clinical trial of activity-focussed physiotherapy on patients with distal radius fractures. Arch Orthop Trauma Surg 2005; 125:515.
  35. Sammer DM, Chung KC. Management of the distal radioulnar joint and ulnar styloid fracture. Hand Clin 2012; 28:199.
  36. Logan AJ, Lindau TR. The management of distal ulnar fractures in adults: a review of the literature and recommendations for treatment. Strategies Trauma Limb Reconstr 2008; 3:49.
  37. Dayican A, Unal VS, Ozkurt B, et al. Conservative treatment in intra-articular fractures of the distal radius: a study on the functional and anatomic outcome in elderly patients. Yonsei Med J 2003; 44:836.
  38. Kelly AJ, Warwick D, Crichlow TP, Bannister GC. Is manipulation of moderately displaced Colles' fracture worthwhile? A prospective randomized trial. Injury 1997; 28:283.
  39. Beumer A, McQueen MM. Fractures of the distal radius in low-demand elderly patients: closed reduction of no value in 53 of 60 wrists. Acta Orthop Scand 2003; 74:98.
  40. Hollevoet N, Verdonk R. Outcome of distal radius fractures in relation to bone mineral density. Acta Orthop Belg 2003; 69:510.
  41. Brüske J, Niedźwiedź Z, Bednarski M, Zyluk A. [Acute carpal tunnel syndrome after distal radius fractures--long term results of surgical treatment with decompression and external fixator application]. Chir Narzadow Ruchu Ortop Pol 2002; 67:47.
  42. Ford DJ, Ali MS. Acute carpal tunnel syndrome. Complications of delayed decompression. J Bone Joint Surg Br 1986; 68:758.
  43. Mack GR, McPherson SA, Lutz RB. Acute median neuropathy after wrist trauma. The role of emergent carpal tunnel release. Clin Orthop Relat Res 1994; :141.
  44. Stockley I, Harvey IA, Getty CJ. Acute volar compartment syndrome of the forearm secondary to fractures of the distal radius. Injury 1988; 19:101.
  45. Simpson NS, Jupiter JB. Delayed onset of forearm compartment syndrome: a complication of distal radius fracture in young adults. J Orthop Trauma 1995; 9:411.
  46. Wang AA, Strauch RJ, Moore JA. Pseudoaneurysm of the ulnar artery occurring after fracture of the distal radius and ulna: a case report. J Hand Surg Am 1998; 23:933.
  47. Cooney WP 3rd, Dobyns JH, Linscheid RL. Complications of Colles' fractures. J Bone Joint Surg Am 1980; 62:613.
  48. Guiral J, Acosta JP, De Benito JI. [Acute compartment syndrome as a complication of a distal forearm fracture: apropos of a case of a child]. Rev Chir Orthop Reparatrice Appar Mot 1995; 81:449.
  49. Younge D. Haematoma block for fractures of the wrist: a cause of compartment syndrome. J Hand Surg Br 1989; 14:194.
  50. Basu A, Bhalaik V, Stanislas M, Harvey IA. Osteomyelitis following a haematoma block. Injury 2003; 34:79.
  51. Dresing K, Peterson T, Schmit-Neuerburg KP. Compartment pressure in the carpal tunnel in distal fractures of the radius. A prospective study. Arch Orthop Trauma Surg 1994; 113:285.
  52. Placzek JD, Boyer MI, Gelberman RH, et al. Nerve decompression for complex regional pain syndrome type II following upper extremity surgery. J Hand Surg Am 2005; 30:69.
  53. Aro H, Koivunen T, Katevuo K, et al. Late compression neuropathies after Colles' fractures. Clin Orthop Relat Res 1988; :217.
  54. Roesgen M, Hierholzer G. Corrective osteotomy of the distal radius after fracture to restore the function of wrist joint, forearm, and hand. Arch Orthop Trauma Surg 1988; 107:301.
  55. Lewis MH. Median nerve decompression after Colles's fracture. J Bone Joint Surg Br 1978; 60-B:195.
  56. Hove LM. Delayed rupture of the thumb extensor tendon. A 5-year study of 18 consecutive cases. Acta Orthop Scand 1994; 65:199.
  57. Bonatz E, Kramer TD, Masear VR. Rupture of the extensor pollicis longus tendon. Am J Orthop (Belle Mead NJ) 1996; 25:118.
  58. Skoff HD. Postfracture extensor pollicis longus tenosynovitis and tendon rupture: a scientific study and personal series. Am J Orthop (Belle Mead NJ) 2003; 32:245.
  59. Catalano LW 3rd, Cole RJ, Gelberman RH, et al. Displaced intra-articular fractures of the distal aspect of the radius. Long-term results in young adults after open reduction and internal fixation. J Bone Joint Surg Am 1997; 79:1290.
  60. Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am 1986; 68:647.
  61. Fernandez JJ, Gruen GS, Herndon JH. Outcome of distal radius fractures using the short form 36 health survey. Clin Orthop Relat Res 1997; :36.
  62. Aro HT, Koivunen T. Minor axial shortening of the radius affects outcome of Colles' fracture treatment. J Hand Surg Am 1991; 16:392.
  63. Warwick D, Field J, Prothero D, et al. Function ten years after Colles' fracture. Clin Orthop Relat Res 1993; :270.
  64. Leung F, Ozkan M, Chow SP. Conservative treatment of intra-articular fractures of the distal radius--factors affecting functional outcome. Hand Surg 2000; 5:145.
  65. Batra S, Gupta A. The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures. Injury 2002; 33:499.
  66. Gliatis JD, Plessas SJ, Davis TR. Outcome of distal radial fractures in young adults. J Hand Surg Br 2000; 25:535.
  67. Hove LM, Fjeldsgaard K, Skjeie R, Solheim E. Anatomical and functional results five years after remanipulated Colles' fractures. Scand J Plast Reconstr Surg Hand Surg 1995; 29:349.
  68. Tsukazaki T, Iwasaki K. Ulnar wrist pain after Colles' fracture. 109 fractures followed for 4 years. Acta Orthop Scand 1993; 64:462.
  69. Hollevoet N, Verdonk R. The functional importance of malunion in distal radius fractures. Acta Orthop Belg 2003; 69:239.
  70. Geissler WB, Freeland AE, Savoie FH, et al. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 1996; 78:357.
  71. Richards RS, Bennett JD, Roth JH, Milne K Jr. Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures. J Hand Surg Am 1997; 22:772.
  72. MacDermid JC, Donner A, Richards RS, Roth JH. Patient versus injury factors as predictors of pain and disability six months after a distal radius fracture. J Clin Epidemiol 2002; 55:849.
  73. Beaulé PE, Dervin GF, Giachino AA, et al. Self-reported disability following distal radius fractures: the influence of hand dominance. J Hand Surg Am 2000; 25:476.
  74. Fujii K, Henmi T, Kanematsu Y, et al. Fractures of the distal end of radius in elderly patients: a comparative study of anatomical and functional results. J Orthop Surg (Hong Kong) 2002; 10:9.
  75. Karnezis IA, Fragkiadakis EG. Association between objective clinical variables and patient-rated disability of the wrist. J Bone Joint Surg Br 2002; 84:967.
  76. Trumble TE, Wagner W, Hanel DP, et al. Intrafocal (Kapandji) pinning of distal radius fractures with and without external fixation. J Hand Surg Am 1998; 23:381.
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