Causes

By far the most common cause of a distal radius fracture is a fall on the extended arm. The arm is instinctively stretched out to absorb the fall and prevent worse from happening. The resulting fracture is called an extension fracture (also called Colles fracture).

However, a fracture can also be caused by a fall on the bent hand – in this case it is called a flexion fracture (Smith fracture). Especially in older patients, falls cause distal radius fractures, as their bone density is often affected by osteoporosis and thus more susceptible to fractures. In these patients, even minor trauma is sufficient to lead to a fracture that would not have resulted in a fracture in healthy patients.

The second most common patient group after older patients are younger patients between five and eighteen years of age. In these patients, sports accidents usually lead to a distal radius fracture. Traffic accidents can also lead to a forearm fracture.

Diagnostics

The diagnosis usually consists of a combination of a patient interview in which the patient describes his symptoms and the accident, an examination of the arm and a final X-ray examination of the arm. Only the x-ray examination can definitively conclude that a distal radius fracture has occurred – patient consultation and examination are not sufficient. During the examination, which is usually only possible to a limited extent due to the patient’s pain, the physician pays attention to a malpositioned arm, restricted movements, as well as sensory and circulatory disorders of the hand. In exceptional cases, when the physician suspects that surrounding ligaments or other structures may still be injured, a magnetic resonance imaging (MRI) examination is performed. Rarely, if several fractures are suspected, a computed tomography (CT) scan is also performed.

Pain

As is common with fractures, pain is also experienced in distal radius fractures. This is due to the fact that in a fracture, the fine periosteum – the periosteum – is pierced by the underlying bone tissue. However, the periosteum is very much interspersed with small nerve fibers that immediately send pain impulses to the brain when irritated.

The background to this is evolutionary biology: a fracture had to be spared even in earlier times and under no circumstances was it allowed to be subjected to further strain, as otherwise blood vessels or nerve tracts could also be affected.Only after weeks, when the fracture has healed, does the pain subside, as injury to surrounding structures is now unlikely. In today’s medicine, painkillers can of course be administered to relieve pain, so that the patient is free of pain. However, this is then a “deceptive peace”, since the basic problem is of course not yet eliminated.

Pain therapy only makes sense if the fracture is simultaneously immobilised and treated surgically or conservatively. Pain – as annoying as it may be – also makes sense, as it signals to the body that it will spare the affected body part. Preclinically freely available painkillers (medically: analgesics) are painkillers of the NSAID group, such as ibuprofen and paracetamol.

In acute cases, an emergency doctor can also use low to high-potency opioids. These are then administered intravenously and eliminate pain very quickly. Painkillers are also usually prescribed for follow-up treatment.

Although Aspirin®, like ibuprofen, belongs to the NSAID class, it also liquefies the blood, which is a nightmare for any surgeon. Vascular injuries can now only be nursed at great expense during surgery. Therefore, the administration of aspirin (generally acetyl-salicylic acid) should be avoided preclinically.