In younger patients, recreational activities may often influence the incidence and pattern of distal radius fractures. Nguyen and colleagues, in a prospective study on osteoporosis in Dubbo, Australia, studied individuals older than 60 years of age and found an incidence of distal radius fractures of 34/10,000 in men compared with 125/10,000 in women. These authors also noted an increase in the incidence over the past 30 years. In contrast, men younger than the age of 65 showed a reduced risk of only 10/10,000 that increased to only 33/10,000 in men older than the age of 85. Thompson and colleagues in the United Kingdom found a female-to-male ratio of 3.9:1, with a premenopausal risk in women of 10/10,000 that increased to 120/10,000 in women older than 85. Studies by Solgaard and Petersen and Jonsson and colleagues in Sweden also confirm an increase in the incidence in wrist fractures over the past several decades. Hagino and colleagues in Japan determined that the incidence of fractures in women increased from 165/100,000 in 1986 to a rate of 211/100,000 in 1995 and that the incidence was lower in Japanese persons than in whites. Several studies demonstrate that both the number and incidence of distal radius fractures have been steadily increasing over the past several decades and have varied in relation to gender, age, and ethnicity. Chung and colleagues, in a review of nearly 1.5 million fractures recorded by the National Hospital Ambulatory Medicare Care Survey, determined that 44% of fractures involved the distal radius of these, 30% occurred from an injury at home and 47% were caused by accidental falls. If the injury occurred in a female with diabetes, the rate of intra-articular fractures nearly doubled. A decreased bone mineral density increased the relative risk of fracture to 1.8, whereas a history of falls increased the relative risk to 1.6. In this sample population, 27% of these fractures presented as an intra-articular pattern and 73% as an extra-articular pattern. Vogt and colleagues examined the incidence and distribution of distal radius fractures treated at four separate medical centers in the United States over a 10-year period and found an overall incidence of person-years. This article outlines the British Orthopaedic Association Standards for Trauma and Orthopaedics for the management of distal radius fractures.īOAST British Orthopaedic Association Standards for Trauma and Orthopaedics Distal radius Falls Fractures Trauma.Fractures of the distal radius are among the most common osseous injuries of the musculoskeletal system. Median nerve compression is the most common complication followed by tendon rupture, arthrosis and malunion.
Patients should be encouraged to mobilise as soon as it is safe to do so, to prevent stiffness. Surgical management options include closed reduction and application of a cast, percutaneous K-wires, open reduction and internal fixation with plates, or external fixation. Immobilisation with or without reduction forms the mainstay of non-operative treatment. Non-operative management in select patients can give good results, especially in older adults. Owing to the heterogeneous injury patterns and patient profiles, the preferred management should consider the severity of the fracture, desired functional outcome and patient comorbidities. Investigations should always include radiographs to evaluate for intra-articular involvement and fracture displacement. On assessment, clinicians should determine the mechanism of injury, associated bony or soft tissue injuries, and neurovascular symptoms. These are commonly the result of a fall on outstretched hands or high-energy trauma. Distal radius fractures account for one in five bony injuries in both primary and secondary care.
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