Distal radius fractures most commonly occur as a result of excessive loading of the wrist in extension but may occur secondary to excessive loading in flexion, axial load, a shearing mechanism, or as a result of a direct blow. This may occur in a wide variety of clinical settings and represent low-, medium-, and high-energy injuries. The most common mechanism is a fall on an outstretched hand. Higher-energy injuries may occur as a result of a motor vehicle accident, a fall from a height, a sporting event, or an industrial injury.

These injuries are seen in all decades of life. Osteoporosis is a significant predisposing factor in elderly persons. A simple fall, which may result in no bony injury in a normal individual, may result in a distal radius fracture in an osteoporotic individual. Generally, a higher-energy mechanism of injury is required to induce a distal radius fracture between the second and sixth decade of life. There
is a significant predominance of distal radius fractures in women beyond the sixth decade because of the prevalence of osteoporosis in this population.

A wide spectrum of physical findings may be encountered because of the wide variation in clinical settings in which distal radius fractures are seen. Invariably, tenderness is present when the distal radius is palpated. Swelling may be quite mild in a low-energy nondisplaced fracture. In high-energy fractures, swelling may be so severe as to arouse suspicion of an acute carpal tunnel syndrome or compartment syndrome. Deformity of the affected wrist and hand may be present with a displaced fracture. Most commonly this will take the form of the so-called “silver fork deformity” (Fig. 1).

Skin integrity must be evaluated carefully. Abrasions from an associated fall are common. Although open fractures of distal radius are most commonly seen in a high-energy injury, open fractures also may be seen following a relatively simple fall in an osteoporotic individual in which significant fracture displacement combined with thin fragile integument result in a Grade 1 open injury.

Appropriate assessment of the neurovascular status of the involved extremity is essential. Median nerve compromise is not uncommon because of the high-energy nature of some of these fractures, as well as the marked displacement that may occur. Sensory and motor assessment of the median and ulnar nerves should be performed. If the examination is abnormal, then reassessment should be done following reduction of the fracture. Vascular compromise may occur as result of these injuries as well. Arterial laceration may occur from the sharp edge of the fracture, especially when severe dorsal displacement of the distal segment occurs. Venous compromise may occur as a result of a markedly displaced position and/or severe swelling. Ongoing assessment of neurovascular status may be necessary in higher-energy injuries, especially following reduction and plaster immobilization.