Distal radius fractures are breaks in the radius bone close to the wrist. The radius is one of the two long bones in the forearm and plays a major role in wrist movement, grip strength, and load transfer through the hand and arm. Distal radius fractures are among the most common fractures seen in clinical practice.
These fractures most commonly occur after a fall onto an outstretched hand, where the force travels through the wrist and forearm. In younger people, distal radius fractures usually result from high-energy trauma such as sports injuries or motor vehicle accidents. In older adults, they frequently occur after low-energy falls and are often associated with reduced bone density.
Symptoms can range from pain and swelling with relatively preserved movement in stable fractures, to obvious deformity, severe pain, and loss of wrist and hand function in displaced injuries. Many distal radius fractures can be managed without surgery, while others require surgical fixation to restore alignment and wrist mechanics.
Physiotherapy for distal radius fractures is essential to restore wrist and hand movement, rebuild strength, and regain functional use of the arm. Early, well-guided rehabilitation helps prevent long-term stiffness, weakness, and loss of independence.
Key Facts
- Distal radius fractures are one of the most common fractures worldwide and represent a significant proportion of upper limb injuries. 🔗
- Falls are the most common mechanism of distal radius fracture in older adults, often associated with osteoporosis.
- Both surgical and non-surgical management of distal radius fractures benefit from early, guided rehabilitation to optimise functional outcomes. 🔗
Risk Factors
- Falls, particularly onto an outstretched hand.
- Reduced bone density or osteoporosis.
- Increasing age.
- High-energy trauma such as sports or motor vehicle accidents.
- Balance impairments or previous falls.
Symptoms
- Pain at the wrist following a fall or trauma.
- Swelling and bruising around the wrist and forearm.
- Visible deformity of the wrist in displaced fractures.
- Difficulty or inability to move the wrist or hand.
- Reduced grip strength.
- Pain with weight-bearing through the hand.
Aggravating Factors
- Attempting to grip, lift, or carry objects.
- Pushing through the hand, such as getting up from a chair.
- Rotating the wrist or forearm.
- Accidental knocks or bumps to the wrist.
- Weight-bearing through the hands during daily tasks.
Causes
Distal radius fractures occur when force is transmitted through the wrist and forearm, most commonly during a fall onto an outstretched hand. The wrist position at impact influences the fracture pattern, with extension injuries being the most common.
In older adults, reduced bone density means that relatively low-energy falls can result in fracture. In younger individuals, higher-energy trauma is usually required. Muscle forces and ligament attachments around the wrist can contribute to displacement of fracture fragments.
The alignment of the distal radius is important for normal wrist mechanics. Malalignment can alter load distribution across the wrist joint and lead to pain, stiffness, and reduced function if not appropriately managed.
Physiotherapists consider fracture stability, treatment method, and healing stage when planning rehabilitation to safely restore wrist and hand function.
How Is It Diagnosed?
Distal radius fractures are diagnosed using a combination of clinical assessment and imaging. A fracture is suspected when wrist pain, swelling, and functional loss occur after trauma.
On examination, there may be tenderness around the distal radius, swelling, bruising, and reduced wrist movement. Deformity may be visible in displaced fractures. Physiotherapists play an important role in recognising possible fractures and referring for imaging.
After diagnosis, physiotherapists use fracture classification, treatment approach, and medical guidance to plan the timing and progression of rehabilitation.
Investigations & Imaging
- X-ray
- Primary imaging to confirm the presence, pattern, and displacement of a distal radius fracture.
- CT scan
- Used in complex or intra-articular fractures to assess joint involvement and guide surgical planning.
Grading / Classification
- Non-displaced fracture
- Fracture fragments remain aligned and are often managed with immobilisation.
- Displaced fracture
- Fragments are angulated or shifted and may require reduction or surgical fixation.
- Intra-articular fracture
- The fracture extends into the wrist joint, increasing the risk of stiffness and arthritis.
Physiotherapy Management
Physiotherapy for distal radius fractures focuses on restoring wrist and hand movement, rebuilding strength, and regaining functional independence. Rehabilitation is guided by fracture stability, healing timelines, and whether surgery was required.
Early physiotherapy aims to reduce swelling and maintain movement in the fingers, elbow, and shoulder while the wrist is protected.
Exercise
Distal radius fracture physiotherapy exercises begin with gentle finger, thumb, and forearm movements to prevent stiffness. Wrist range-of-motion exercises are introduced once immobilisation is reduced or removed.
Strengthening exercises for the wrist, forearm, and grip are gradually progressed as healing allows, followed by functional tasks such as lifting, pushing, and weight-bearing through the hand.
Activity Modification
Activity modification includes avoiding heavy lifting, pushing, or weight-bearing through the wrist early in recovery. Activities are gradually reintroduced based on pain, strength, and movement.
Manual Therapy
Manual therapy may be used to address wrist, hand, and forearm stiffness once fracture healing allows.
A 2022 systematic review found the addition of mobilisation with movement and manual lymphatic drainage to rehabilitation programs improved upper limb function and reduced swelling.
Heat & Ice
Ice can help manage pain and swelling early. Heat may assist with stiffness later in rehabilitation.
Education
Education helps patients understand healing timelines, safe loading, and the importance of completing rehabilitation.
Other
Other considerations include ergonomic advice, return-to-work planning, and coordination with medical teams.
Other Treatments
Other treatments may include immobilisation in a cast or splint, pain relief prescribed by a doctor, and follow-up imaging to monitor healing.
Surgery
Surgery may be required for unstable, significantly displaced, or intra-articular distal radius fractures. Fixation methods include plates, screws, or pins.
Physiotherapy after surgery is essential to restore wrist movement, strength, and function.
Prognosis & Return to Activity
The prognosis for distal radius fractures is generally good, particularly for stable fractures managed conservatively.
Bone healing typically occurs over 6–8 weeks, but full recovery of wrist strength and function may take several months. Consistent physiotherapy is key to achieving the best outcome.
Complications
- Wrist stiffness and reduced range of motion.
- Reduced grip strength.
- Post-traumatic wrist arthritis, particularly after intra-articular fractures.
- Complex regional pain syndrome in rare cases.
Preventing Recurrence
- Address fall risk and balance, especially in older adults.
- Maintain wrist and forearm strength after recovery.
- Optimise bone health through exercise and medical care.
When to See a Physio
- You have wrist pain and swelling after a fall.
- You have been diagnosed with a distal radius fracture and need rehabilitation guidance.
- Your wrist stiffness or weakness is not improving as expected.