Distal radius fracture in Adult
Alerts and Notices
Synopsis
Causes / typical injury mechanism: The majority of distal radius fractures are osteoporotic fractures from low-energy falls, with 66%-77% of cases occurring from falling on an outstretched hand (FOOSH) and only 10% from high-energy injuries.Often, a distal radius fracture is the first sign that underlying bone health is suboptimal. Women who sustain a low-energy distal radius fracture are 5 times more likely to sustain a vertebral fracture and twice as likely to sustain a hip fracture during their life. For men, studies have shown that those with a history of distal radius fracture have a 10-fold increased risk for vertebral fractures.
Classic history and presentation: A woman older than 65 years with osteoporosis or osteopenia who presents with a FOOSH injury after falling from a standing height.
Prevalence: Distal radius fractures are the most common type of adult fracture, making up about 17.5% of all fractures in the United States.
- Age – There is a bimodal distribution among the age groups that tend to sustain these fractures: youth and young adults with high-energy sports injuries, and older adults with osteoporotic fractures.
- Sex / gender – Distal radius fractures are more prominent in men with a high-energy mechanism of injury during middle adulthood. In late adulthood, this is more prominent in women, with a fivefold increase in rate of fractures among women when compared to men older than 65 years due to the bone density changes that occur in women following menopause.
Grade / classification system: There are numerous classification systems. The most commonly used when discussing distal radius fractures include:
- Colles fracture – Extra-articular distal radius fracture with dorsal displacement and associated ulnar styloid fracture.
- Smith fracture – Extra-articular distal radius fracture with volar displacement.
- Barton fracture – Volar or dorsal "shear" fracture with associated volar or dorsal lip and dislocation of the radiocarpal joint.
- Chauffeur's fracture – Radial styloid fracture.
- Die-punch fracture – Intra-articular. Involves the lunate facet portion of the articular surface.
Codes
ICD10CM:S52.509A – Unspecified fracture of the lower end of unspecified radius, initial encounter for closed fracture
S52.509B – Unspecified fracture of the lower end of unspecified radius, initial encounter for open fracture type I or II
S52.509C – Unspecified fracture of the lower end of unspecified radius, initial encounter for open fracture type IIIA, IIIB, or IIIC
SNOMEDCT:
263199001 – Fracture of distal end of radius
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Scaphoid fracture – Assess for tenderness within the anatomic snuffbox.
- Other carpal fractures or dislocations
- Injury to the distal radial ulnar joint (DRUJ)
- Injury to the triangular fibrocartilage complex (TFCC)
- Wrist sprain or ligamentous injury
- Septic arthritis – Look for redness, warmth, and erythema. Can do joint aspiration if suspicion is high.
- Gout or calcium pyrophosphate deposition disease
- Metastatic bone lesions resulting in a pathologic fracture
Best Tests
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Management Pearls
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Therapy
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References
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Last Reviewed:02/14/2022
Last Updated:04/04/2022
Last Updated:04/04/2022
Distal radius fracture in Adult