What is a Fixation of Distal Radius Fractures (Wrist Fractures)?
Fixation of distal radial fracture is the re-aligning of fractured wrist bone (reduction) and holding the bone in the correct position, using plate and screws, metal pins, an external fixator or any combination of these techniques.
Distal radial fractures are very common. The fractures are characterised by the direction of forces applied to the wrist during a fall.
Colles fracture occurs when someone falls on their outstretched hand, where the hand is extended backward on their wrist. This is seen commonly in bike, car, skiing accident and etc.
Post-menopausal women and people with osteoporosis are more prone to this type of injury.
Who is this operation for?
Indications for surgery:
- Fracture that tends to displace after bone realignment (unstable fracture)
- Position of the bone is not suitable for the future function of your arm (displaced)
- Position of the bone cannot be corrected by pushing on it (closed reduction)
- Fracture cannot be recovered in a cast
- Patients who cannot accept the constraints of cast treatment because of work or recreational activities
Complications
The risks and complications of a Fixation of Distal Radial Fracture:
General complications:
- Bleeding
- Infection
- Pain
Specific complications:
- Wrist and hand stiffness
- Non-union – a fracture fails to unite
- Mal-union – a fracture heals with deformity
- Implant related tendon irritation
- Damage to the surrounding nerves and blood vessels
- Hardware failure
- Failure to recognize concomitant injuries
Before the operation
Preadmission Clinic | Preparing for Surgery
Before your operation, you will be seen at the preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.
During the visit, you will be seen by a:
- Doctor
- Nurse
- Anaesthetist (if necessary)
Tests
Tests that may be ordered for you include:
- blood tests
- Xray wrist
- Urine Test
- ECG
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.
Medications
Our doctors will advise you which medications you should stop or can continue taking before surgery.
Tip
Carry a list of your medications with you including the name, dosage and how often you take it.
About the Operation
The anaesthetist may use general or local anaesthesia to prevent pain during the operation. During the surgery, your surgeon makes an incision over the fracture. He/ she will then improve the alignment of the fracture and use an implant to stabilise the pieces for example, a plate and screws. This is called ‘internal fixation’.
The hardware implant is covered by soft tissues of the wrist and skin. Occasionally, external frames are used to keep the bones aligned. However, this is only temporary and is removed after a few weeks once the bones have healed. This is called ‘external fixation’.
Advantages of internal fixation (plate, screws and pins) include:
- Strategic placement of implants
- Improved stability
- Reduce the need of an external device
- Earlier use of the hand
Disadvantages of internal fixation include:
- Infection
- Stiffness
- Nerve injury
- Improper positioning of the plate and screws
Advantages of external fixation include:
- Minimal soft tissue disruption
- Less scarring from skin incision
- All hardware is removed ( no concerns for airport security)
- Bone graft may be used to support the joint surface
Disadvantages of external fixation include:
- Bulky metal or plastic frame around the wrist
- Protrusion of pins from skin surface
- incapability to begin hand therapy for several weeks after surgery
Surgery does not ‘heal’ the fracture, instead it holds the bone in the correct alignment and allows the body to bridge the fracture with new bone. This healing process takes up to few weeks or months.
After the Operation
Most fractures hurt moderately for a few days to a couple of weeks. Pain killer medications will be prescribed to relieve the pain, and should be weaned as the pain improves over time.
Rest and elevation of your arm above the level of the heart is essential to reduce swelling. Your surgeon may recommend wrist, fingers, thumb, elbow and shoulder exercises to help prevent stiffness. Most patients get a soft dressing and a soft splint. Splints must be kept dry. A plastic bag over the arm while showering should help. Splint should be removed in 3 days. Most surgical incisions have to kept clean and dry for 5 days or until the stitches are removed. Dressing is discontinued 5 days after surgery, you can leave it open, or if you prefer cover it with a bandaid.
Recovery and Rehabilitation
Most patients do return to their work and recreational activities, and do not have permanent pain. The recovery rate is different for each individual. Factors that might affect recovery rate include, the nature of the injury, the types of treatment received and body’s response to the surgical procedure.
Most patients who do light activities such as painting, office work activities (typing, telephone) can return to work between 1- 2 months. Most patients can resume vigorous activities such as tennis, baseball and football between 4 – 6 months after the injury.
Almost everyone will end up with some stiffness after the surgery. Improvement will continue for at least 2 years. However, in patients older >50 years of age, patients who suffer from osteoarthritis, and those involved in high-energy injuries such as motor vehicle accidents might have residual stiffness and ache permanently.
Most patients will start hand therapy, within a few days to weeks after surgery. The main aim is to reduce swelling, pain, stiffness and increase the strength and movement of joints and muscles of the wrist.
These are general guidelines that may not apply to you or the type of fracture. Ask your doctor for specifics in your case.
F.A.Q.s | Frequently Asked Questions
How can I prevent this from happening again?
Some distal radial fractures are related to reduced bone density (osteoporosis). Most patients with osteoporosis can reduce their fracture risk with medications or lifestyle changes. Ask your doctor whether you need to be screened or treated for osteoporosis.
Prognosis
The long term prognosis for a properly treated distal radius fracture is good, even with an intra-articular fracture. Osteoarthritis is rare if the affected bone surface is not severely damaged and is able to be constructed.