Distal Radius Fracture:
The Broken Wrist, Explained

What the distal radius is, and why it breaks

The radius is one of the two forearm bones, and its "distal" end forms the larger part of the wrist joint, sitting under the base of the thumb and index finger. When a person falls and instinctively puts a hand out to break the fall, the force travels up through the palm and concentrates at this end of the radius — which is relatively broad, mostly made of the lighter, more fracture-prone trabecular bone, and sits at a natural mechanical weak point. That combination makes it, by a wide margin, the most frequently fractured bone in the human body after a fall on an outstretched hand.

What makes this fracture unusual is its age distribution. Rather than affecting one group predominantly, distal radius fractures cluster at two very different points in life: adolescence, where bone is still growing and injuries tend to come from higher-energy activity such as sport, falls from bicycles, or skateboarding; and later adulthood, particularly in postmenopausal women, where the bone itself has become more fragile and a simple fall from standing height is enough to break it.

Symptoms and what the wrist looks like

The typical presentation is immediate pain at the wrist after a fall, along with swelling, bruising, and reluctance or inability to move the wrist or grip anything. In a displaced fracture, the wrist may appear visibly bent or deformed — an appearance classically described as a "dinner fork" deformity, where the hand sits angled backward relative to the forearm. Numbness or tingling in the thumb, index, and middle fingers can occur if swelling or bone displacement puts pressure on the median nerve, which runs directly beneath the fracture site through the carpal tunnel.

How it's classified

Not all distal radius fractures are the same, and the terminology can be confusing because several patterns carry the names of the surgeons who first described them. In practice, the distinctions that matter most are the direction of displacement, whether the fracture line enters the wrist joint itself (intra-articular) or stays outside it (extra-articular), and whether the fragments remain reasonably aligned or are significantly shifted out of position.

Pattern	Description	Typical mechanism
Colles' fracture	Fragment displaced backward (dorsally) and often tilted; the most common pattern overall	Fall onto an outstretched, extended hand
Smith's fracture	Fragment displaced forward (volarly) — sometimes called a "reverse Colles"	Fall onto a flexed wrist, or a direct blow to the back of the wrist
Barton's fracture	Fracture-dislocation involving the joint surface, with the wrist bones shifting along with the fragment	Higher-energy fall or impact
Intra-articular / comminuted	Fracture line extends into the wrist joint, often with multiple bone fragments	Higher-energy trauma, more common in younger patients

How the diagnosis is made

Plain X-rays of the wrist, taken from at least two angles, are the standard first step and are usually sufficient to confirm the fracture, assess displacement and angulation, and guide initial treatment decisions. When the fracture is complex, extends into the joint, or surgery is being considered, a CT scan is often added: it shows the three-dimensional pattern of the joint surface far more clearly than X-ray alone and can reveal fragments or step-offs in the joint that change the treatment plan. MRI is used less often, generally reserved for cases where an associated soft-tissue injury — to the triangular fibrocartilage complex or the ligaments between the small wrist bones — is suspected but not clear on other imaging.

Treatment: casting or surgery

The central treatment question for most distal radius fractures is whether the bone can be, and should be, held in an acceptable position with a cast alone, or whether it needs surgical fixation — typically with a plate and screws placed on the palm side of the bone (a volar locking plate), or occasionally with wires (K-wires) or an external frame. The honest answer, informed by a substantial body of trial evidence over the past decade, is that this decision is more nuanced than "worse fractures always need surgery."

Taken together, this evidence base has shifted practice toward a more individualised conversation, particularly for older, lower-demand patients: a well-molded cast with close radiographic follow-up is a reasonable and often preferred option even for some displaced fractures, while surgery remains clearly favoured for fractures that are unstable, significantly displaced into the joint, associated with nerve symptoms, or in younger, higher-demand patients where restoring anatomy precisely matters more for long-term function.

Approach	Typically used when	Trade-offs
Closed reduction + cast	Stable, minimally displaced, or successfully realigned fractures	No surgical risk; requires follow-up X-rays to check the position holds
Volar locking plate	Unstable, significantly displaced, or intra-articular fractures; younger or higher-demand patients	Allows earlier motion; carries surgical and hardware-related risks
K-wire fixation	Selected displaced extra-articular fractures needing added stability	Less invasive than plating; pins usually removed after several weeks
External fixation	Severely comminuted fractures or where soft-tissue injury limits other options	Reserved for more complex or open injuries

Rehabilitation and what recovery looks like

Whether the fracture is treated with a cast or surgery, structured rehabilitation plays a significant role in how well and how quickly function returns. A 2024 clinical practice guideline from the Academy of Orthopaedic Physical Therapy and the Academy of Hand and Upper Extremity Physical Therapy addressed this specifically for distal radius fracture recovery.

For an uncomplicated fracture treated in a cast, immobilisation typically lasts around 4 to 6 weeks, followed by a period of progressive stretching and strengthening. After surgical fixation with a locking plate, many patients are guided into earlier protected motion, since the hardware itself provides enough stability to permit gentle exercise sooner — though the exact timeline is always set by the treating surgeon based on the fracture pattern and how surgery went. Full recovery of grip strength and fine motor function can take several months, and in older patients or more complex fractures, some residual stiffness or reduced grip strength compared with the uninjured side is common even after a technically successful outcome.

Possible complications

Most distal radius fractures heal well, but a minority of patients experience complications worth knowing about: malunion, where the bone heals in a shifted position that can affect wrist motion or grip strength; stiffness of the wrist or fingers, especially if early finger motion isn't encouraged during immobilisation; carpal tunnel syndrome from nerve compression at the time of injury or during healing; and, uncommonly, complex regional pain syndrome, a poorly understood condition causing disproportionate pain, swelling, and sensitivity after the injury. Recognising these possibilities early, rather than dismissing ongoing symptoms as "normal after a broken bone," is part of why continued follow-up with the treating team matters even after the cast comes off or the surgical wound has healed.

When to see a specialist

Any suspected wrist fracture after a fall — visible deformity, significant swelling, or an inability to move or bear weight through the hand — warrants prompt evaluation with an X-ray rather than waiting to see if it improves. This is especially true for older adults, since a low-energy wrist fracture can be the first sign of underlying osteoporosis and is itself a recognised marker of increased risk for future fragility fractures, including of the hip. A conversation about bone health, and potentially a bone density scan, is a reasonable next step for anyone who breaks a wrist from a simple fall.