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Distal radius fracture in Adult
Other Resources UpToDate PubMed

Distal radius fracture in Adult

Contributors: Shannon M. Kaupp MD, Danielle Wilbur MD
Other Resources UpToDate PubMed

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.
Risk factors: There are many risk factors including older age, low bone density scores on DEXA scan, female sex, winter season (due to slips and falls on ice), and frequent falls. Some studies have found that the risk increases in adults who are more active and participate in strenuous activities. Many of these are considered fragility fractures, and thus the severity of the fracture is closely related to bone composition. Health conditions that have a negative effect on bone mineral density, leading to an increased risk of sustaining a fragility fracture include diabetes, rheumatoid arthritis, kidney disease, and stroke.

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
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Distal radius fracture in Adult
Copyright © 2022 VisualDx®. All rights reserved.