Abhinav Gulihar is a highly experienced orthopaedic surgeon providing specialist care for patients in London and Kent. As a consultant with a specialist interest in hand and wrist surgery, he treats a wide range of conditions, including simple and complex distal radius fractures.
A distal radius fracture—commonly referred to as a broken wrist—is one of the most frequent injuries treated by orthopaedic surgeons. It occurs when the radius bone breaks close to the wrist joint, most often following a fall onto an outstretched hand. These fractures range from stable, minimally displaced injuries to complex fractures involving the joint surface.
Treatment is individualised. Many wrist fractures heal well without surgery, while unstable or displaced fractures may require surgical fixation to restore alignment and long-term wrist function.
Understanding Distal Radius Fractures
The distal radius plays a crucial role in wrist movement, grip strength, and forearm rotation. A fracture in this region can significantly affect hand function if alignment is not restored.
Fractures are assessed based on:
- Degree of displacement
- Stability
- Involvement of the joint surface (intra-articular fractures)
- Bone quality
- Functional demands of the patient
The aim of treatment—whether non-operative or surgical—is to restore anatomy, promote healing, and minimise long-term stiffness and arthritis.
Non-Operative (Conservative) Management
Many distal radius fractures can be treated without surgery, particularly when they are stable and well aligned.
Cast or Splint Immobilisation
- Used for non-displaced or minimally displaced fractures
- Immobilisation typically lasts 4–6 weeks
- Regular X-rays are required to ensure the fracture remains well positioned
Early Monitoring
Some fractures may shift during the first few weeks. Close follow-up might be required, especially in the first 2–3 weeks after injury.
Pain and Swelling Management
- Elevation of the hand
- Ice application
- Simple pain relief
- Finger, elbow, and shoulder movement encouraged to prevent stiffness
When Surgery Is Recommended
Surgery is more likely to be advised if:
- The fracture is displaced or unstable
- Alignment cannot be maintained in a cast
- The fracture extends into the joint
There is a high risk of long-term stiffness or arthritis without fixation
Complex and Intra-Articular Wrist Fractures
Some distal radius fractures are more complex and may require surgical fixation to achieve the best outcome. These include:
- Intra-articular fractures (fracture extends into the wrist joint)
- Comminuted fractures (multiple bone fragments)
- Fractures with loss of length or tilt, affecting wrist mechanics
- Osteoporotic fractures, particularly in older adults
CT scanning may be used to assess joint involvement and guide surgical planning.
Surgical Treatment: Open Reduction and Internal Fixation (ORIF)
Open Reduction and Internal Fixation (ORIF)
ORIF is the standard surgical treatment for unstable or displaced distal radius fractures.
- An incision allows direct realignment of the fracture
- A contoured metal plate and screws hold the bone in position
- Provides strong fixation and often allows earlier wrist movement
This technique is particularly effective for:
- Displaced fractures
- Intra-articular fractures
Fractures where precise alignment is required
What to Expect From Surgery
The goal of surgery is to restore the normal anatomy of the wrist, allowing the bone to heal in the correct position and reducing the risk of long-term problems.
Most patients experience:
- Gradual reduction in pain as healing progresses
- Improvement in wrist movement and grip strength
Continued improvement for 6–12 months after surgery
Recovery After Wrist Fracture Surgery
Recovery is gradual and guided by specialist hand therapy.
0–2 Weeks
- Splint or dressing
- Elevation and swelling control
2–6 Weeks
- Gentle wrist movement begins
- Hand therapy introduced
6–12 Weeks
- Progressive strengthening
- Return to light daily activities
3–12 Months
- Continued gains in strength and movement
- Final functional outcome becomes apparent
Potential Complications and Risks (Revised)
Wrist fracture treatment—both non-operative and surgical—is generally very successful, but complications can occur.
Common or Expected
- Swelling
- Wrist stiffness
- Temporary weakness
Risks Related to Casting
- Loss of fracture position
- Joint stiffness
- Skin irritation
Surgical Risks (ORIF)
- Infection – uncommon and usually superficial
- Bleeding or bruising
- Delayed wound healing
Nerve and Tendon Issues
- Temporary numbness or tingling
- Tendon irritation from plates or screws
- Tendon rupture (rare)
Bone-Related Complications
- Non-union (failure to heal) – rare
- Malunion (healing in altered alignment)
- Hardware irritation, occasionally requiring removal
Long-Term Considerations
- Reduced wrist movement
- Post-traumatic arthritis, especially after joint fractures
Most complications are minor and manageable, and serious problems are uncommon.
Frequently Asked Questions
Do all wrist fractures need surgery?
No. Many fractures heal well in a cast. Surgery is recommended when alignment or stability cannot be maintained.
How long will I need a cast or splint?
Usually 4–6 weeks, depending on the fracture and treatment.
Will the plate and screws need to be removed?
Usually not. Removal is only required if they cause irritation after healing.
When can I drive again?
Once you are out of the splint and have safe strength and movement—often 6–12 weeks.
Will my wrist return to normal?
Most patients regain good function, though some stiffness is common, particularly after complex fractures.
Is hand therapy really necessary?
Yes. Hand therapy is essential for restoring movement and strength.
What increases the risk of complications?
Smoking, diabetes, osteoporosis, and severe fractures can increase risk.
Can arthritis develop later?
Yes, especially after fractures involving the joint surface, even with optimal treatment.
Book Your Appointment with Mr Abhinav Gulihar
If you have sustained a wrist fracture or would like a specialist opinion on treatment options, early assessment is key to achieving the best outcome. To book a consultation with Mr Abhinav Gulihar in London or Kent, please contact the clinic.