Sports Medicine
Sports Injury Prevention & Rehabilitation

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Radius Fracture

(Also known as a Colles' Fracture, Broken Wrist, Wrist Fracture, Fractured Radius, Distal Radius Fracture, Broken Radius)
What is a radius fracture?
A radius fracture is a relatively common condition characterized by a break in one of the long bones of the forearm known as the radius.
The forearm comprises of two long bones known as the radius and ulna which are situated beside each other. The radius bone lies on the thumb side of the forearm and forms joints with the ulna (near the elbow and wrist) and several small bones at the wrist.
During certain activities such as a fall on the outstretched hand, stress is placed on the radius bone. When this stress is traumatic and beyond what the bone can withstand a break in the radius may occur. This condition is known as a radius fracture.
A radius fracture is common among the elderly, but can also occur in the younger patient. Often a fracture to the radius occurs in combination with fractures to other bones such as the ulnar or scaphoid.

Causes of a radius fracture
A radius fracture most commonly occurs due to a traumatic weight bearing force through the wrist such as a fall onto an outstretched hand. This may occur with any fall, but is particularly common in sports such as skateboarding or snowboarding (particularly in icy conditions) where a fall onto a hard surface is unforgiving.

Signs and symptoms of a radius fracture

Patients with this condition typically experience a sudden onset of sharp, intense wrist or forearm pain at the time of injury. This often causes the patient to cradle the affected arm so as to protect the wrist. Pain is usually felt on the thumb side of the wrist and forearm and can occasionally settle quickly leaving patients with an ache at the site of injury that is particularly prominent at night or first thing in the morning. Patients with a radius fracture may also experience swelling and pain on firmly touching the affected region of the bone. Pain may also increase during certain movements of the wrist, when gripping or during weight-bearing activity (such as pushing) through the affected wrist. In severe radius fractures (with bony displacement), an obvious deformity may be detected.

Diagnosis of a radius fracture

A thorough subjective and objective examination from a physician is essential to assist with diagnosis of a radius fracture. An X-ray is usually required to confirm diagnosis. Further investigations such as an MRI, CT scan or bone scan may be required, in some cases, to assist with diagnosis and assess the severity of injury.

Treatment for a radius fracture
Treatment for a fractured radius typically involves anatomical reduction (i.e. re-alignment of the fracture by careful manipulation under anesthetic) followed by immobilization in a plaster cast for 6 weeks. Evaluation of the fracture during this period with follow up X-rays is important to ensure the fracture is healing in an ideal position. Once healing is confirmed and the plaster cast has been removed, rehabilitation can begin as guided by the treating physical therapist.
One of the most important components of rehabilitation following a radius fracture is that the patient rests sufficiently from any activity that increases their pain. Activities which place large amounts of stress through the radius should also be avoided particularly weight bearing or pushing activities. Rest from aggravating activities allows the healing process to take place in the absence of further damage. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms. This should take place over a period of weeks to months with direction from the treating physical therapist.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to cause further damage and may slow healing or prevent healing of the radius fracture altogether.
Patients with a fractured radius should perform pain-free flexibility and strengthening exercises as part of their rehabilitation to ensure an optimal outcome. This is particularly important, as soft tissue flexibility and strength are quickly lost with plaster cast immobilization. The treating physical therapist can advise which exercises are most appropriate for the patient and when they should be commenced.
Occasionally, surgical intervention may be indicated in patients with this condition. This is most common in severe radius fractures (with displacement) or in those cases that do not respond to conservative treatment. Surgery typically involves internal fixation (often with plates and screws) to stabilize the fracture.

Prognosis of a radius fracture
Patients with a fractured radius usually make a full recovery with appropriate management (whether surgical or conservative). Return to activity or sport can usually take place in weeks to months and should be guided by the treating physical therapist and specialist. In patients with severe injuries involving damage to other bones, soft tissue, nerves or blood vessels, recovery time may be significantly prolonged.

Physical therapy for a radius fracture
Physical therapy treatment (particularly following removal of the plaster cast) is vital in all patients with this condition to hasten healing and ensure an optimal outcome. Treatment may comprise:
  • soft tissue massage
  • joint mobilization
  • electrotherapy (e.g. ultrasound)
  • taping or bracing
  • exercises to improve strength and flexibility
  • education
  • activity modification
  • a graduated return to activity plan

Other intervention for a radius fracture
Despite appropriate physical therapy management, some patients with this condition do not improve adequately and may require other intervention. The treating physical therapist or doctor can advise on the best course of management when this is the case. This may include further investigations such as X-rays, CT scan, MRI or bone scan, extended periods of plaster cast immobilization or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the fractured radius. Occasionally, patients may require surgery to stabilize the fracture and a bone graft to aid fracture healing.