ORIF of Distal Radius Fracture

What is a Distal Radius Fracture?

The forearm consists of two bones, the radius and ulna. The radius is the larger of the two forearm bones, and the region towards the wrist is called the distal end. A fracture or break in the distal end of the radius bone is known as a distal radius fracture.

A distal radius fracture generally occurs around 1 inch from the distal end of the wrist and can occur in various ways. The most commonly occurring distal radius fracture is the Colles fracture, which leads to an upward tilting of the broken radius bone. Other types of distal radius fractures include:

• Intra-articular fracture: Fracture extending into the wrist joint
• Extra-articular fracture: Fracture not extending into the wrist joint
• Open fracture: Fractured bone, which breaks through the skin
• Comminuted fracture: Bone fractured into more than two pieces

What is ORIF?

ORIF or open reduction and internal fixation is a surgical technique employed for the treatment of a fracture to restore normal anatomy and improve range of motion and function.

Causes 

Falling onto an outstretched arm is the most common way to fracture the distal radius. Other causes include:

• Minor falls with the presence of osteoporosis (fragile bones)
• Major trauma to the wrist during a vehicular accident

Signs and Symptoms

The signs and symptoms of distal radius fractures include:

• Bruising
• Swelling
• Immediate pain and tenderness
• Limited mobility
• Deformity of the wrist

Diagnosis

Your doctor will diagnose a distal radius fracture by reviewing your signs and symptoms and performing a thorough physical examination. Your physician will:

• Inspect the skin at the fracture site as bone fragments can cut through the skin and create lacerations.
• Palpate your arm to determine areas of tenderness indicating soft tissue injuries or broken bones.
• Check your pulse at the wrist to ensure good blood flow from the forearm to your hand.
• Check your fingers and wrist for proper hand movements as injury to nerves may cause weakness and numbness of the hand and wrist.

Your doctor may also order an X-ray of the forearm to confirm the fracture. Sometimes, a computer tomography (CT) scan may be required to get a detailed view of the fractured fragments as well as injury to soft tissues.

Preparation for Surgery

Prior to ORIF of the distal radius fracture, you may have:

• Physical exam to inspect blood circulation and nerves affected by the fracture
• X-ray, CT scan, or MRI scan to assess surrounding structures and broken bone
• Blood tests
• Depending on the type of fracture you have sustained, you may be given a tetanus shot if you are not up to date with your immunisations
• A discussion with an anaesthesiologist to determine the type of anaesthesia you may undergo
• A discussion with your doctor about the medications and supplements you are taking and if any should be stopped
• A discussion about the need to avoid food and drink past midnight the night prior to your surgery

Procedure for ORIF of the Distal Radius Fracture

Open reduction and internal fixation is the procedure employed most often to treat severe distal radius fractures.

The surgery is performed under sterile conditions in the operating room under general or local anaesthesia.

• After sterilising the affected area, your surgeon will make an incision over the site of the fracture.
• Your surgeon will locate the fracture by carefully sliding in between the muscles of the forearm.
• The cuts from the injury and surfaces of the fractured bone are thoroughly cleaned out.
• After carefully visualising the fracture, the bone fragments are first repositioned into their normal alignment (reduction).
• The fragments of bone are then held in place together with wires, screws, pins, or metal plates attached to the outer surface of the bone (fixation).
• After securing the bone, the incisions are closed by suturing or staples and covered with sterile dressings to complete the operation.

Postoperative Care

You may have some pain post procedure and pain medication will be prescribed to keep you comfortable. After surgery, your forearm will be placed in a short splint for support and protection. You will need to keep your arm immobile for several weeks with the aid of a sling to allow bone healing. Your doctor will provide instructions on dressings and incision care.

Physiotherapy is suggested to prevent forearm stiffness, strengthen muscles, and restore range of motion. You will also be advised on a healthy diet and supplements high in vitamin D and calcium to promote bone healing.

Depending on your health condition and the extent of the injury, you may be able to go home the same day with scheduled follow-up appointments for monitoring progress and for stitches or staple removal if necessary. Most people are able to return to all their normal activities within a few months.

Risks and Complications

As with any surgery, some of the potential risks and complications of ORIF of distal radius fractures may include:

• Bleeding
• Swelling
• Infection
• Pain
• Anaesthetic complications
• Damage to nerves and blood vessels
• Hardware irritation
• Nonhealing of the fracture
• Broken hardware
• Need for repeat surgery