Broken Wrist (Distal Radius Fracture): Symptoms, Treatment and Recovery

What is a broken wrist?

The forearm has two bones. The one on the thumb side is called the radius. The end of this bone nearest the wrist is called the distal radius, and it is the most common place for a wrist fracture ^[1].

The break may be straight and stay in place. In other cases the bone fragments shift out of position, or the fracture line runs into the joint surface. The shape and stability of the fracture are among the main factors that decide between a cast and surgery ^[1]⁠^[3].

Symptoms

Symptoms usually start straight after the fall. The most common are ^[1]⁠^[2]:

• Sudden, marked pain in the wrist
• Swelling and bruising
• Tenderness when the area is touched
• Difficulty moving the wrist and hand
• A bent or deformed-looking wrist if the bone has shifted
• Numbness or tingling in the fingers

Causes and risk factors

The most common cause is putting a hand out to break a fall. In younger people these fractures more often follow high-energy injuries, such as a fall from a height, a road accident or a sports injury ^[1].

In older people, especially those with osteoporosis (thinning bones), even a simple fall from standing can break the wrist. A wrist fracture in an older person can therefore be an important sign of weak bones, and an assessment of bone health and falls risk is recommended ^[1]⁠^[3].

It is not always possible to tell a sprain from a fracture just by looking. If wrist pain does not settle after a fall, an examination and X-ray are needed ^[2].

Diagnosis

The doctor first asks how the injury happened. They then examine the wrist, checking the skin, the blood supply and the feeling in the fingers ^[3].

The diagnosis is confirmed with X-rays taken from the front and the side ^[3]. If the fracture extends into the joint or surgery is being planned, a CT scan may be used to see the bone in more detail ^[1].

Guidelines recommend that people are offered the chance to see their images and understand their injury, and are given spoken and written information about treatment and recovery ^[4].

Treatment

Non-surgical treatment: if the fracture is not displaced or is in an acceptable position, a splint or cast may be enough. A splint that allows for swelling is often used for the first days, followed by a cast if needed. This support usually stays on for 4–6 weeks ^[1].

If the fragments have shifted, they can often be moved back into place from the outside without an incision. This is called closed reduction and is done with adequate pain relief. The wrist is then protected in a cast ^[1]⁠^[3]⁠^[4].

Surgical treatment: surgery is considered if the cast cannot hold the fracture in place, if the joint surface is disrupted, or if the fracture slips again during follow-up. The fragments are held with a metal plate and screws, wires, or a frame fixed outside the skin (external fixator) ^[1]⁠^[4].

When surgery is needed, timing matters. Guidelines recommend operating within 72 hours for fractures that enter the joint and within one week for fractures outside the joint ^[3]⁠^[4].

Age plays an important part in the decision. In people aged 65 and over without major deformity, even displaced fractures can often be treated without surgery ^[3]. A meta-analysis pooling many studies found that surgery gave slightly better hand function and grip strength overall, but studies that included only patients over 60 showed no meaningful difference in function ^[5]. Treatment is therefore chosen by weighing the fracture type, age, how demanding the person's hand use is, and their general health.

Recovery

The broken bone usually heals in 6–8 weeks, although severe fractures can take longer ^[2]. Using the wrist comfortably for all daily tasks may take around 3 months, and full recovery can take up to a year ^[1].

After the splint or cast comes off, physiotherapy and home exercises help restore wrist movement and strength. In suitable cases, early movement in a removable support can begin once pain allows ^[1]⁠^[3].

Some people are left with mild stiffness or a long-lasting ache in the wrist. Rarely, a condition called complex regional pain syndrome develops, causing prolonged pain that is out of proportion to the injury. Pain that does not settle should always be reported to a doctor ^[1].

Guidelines recommend an easy way to return for review if recovery is not going as expected, and an assessment of bone health and falls risk in older people ^[3].

When to seek urgent care

Go to an emergency department without delay if you notice any of the following ^[1]⁠^[2]:

• Numbness or tingling in the fingers
• An obvious deformity of the wrist or arm
• Bone showing through the skin or heavy bleeding
• Severe pain that keeps getting worse despite rest
• Extreme pain when the fingers are gently straightened, or weakness of the thumb and index finger
• Until you reach hospital: support the arm with a towel or sling, apply ice wrapped in a cloth for short periods, remove rings and bracelets straight away, and do not eat or drink in case surgery is needed ^[2]