Distal radius fracture fixation is an operation to realign and stabilise a broken wrist. It is one of the most common fractures treated by orthopaedic surgeons. Surgery involves using a metal plate and screws to hold the bone in the correct position while it heals.
An incision is made over the front (palmar side) of the wrist. The fracture fragments are realigned under direct vision and fixed with a metal plate and screws (volar locking plate). In some cases, pins, an external fixator, or dorsal approach may be used. The wound is closed and a splint or plaster is applied. The operation usually takes 45–90 minutes.
Surgery is recommended when the fracture is significantly displaced and cannot be adequately reduced (repositioned) or maintained in a plaster cast. Surgery is also considered when the fracture involves the joint surface, when the bone is unstable, or when the fracture has re-displaced after initial cast treatment.
Many wrist fractures can be treated with a plaster cast for approximately six weeks. The decision depends on fracture pattern, displacement, stability, and patient factors. Undisplaced or minimally displaced fractures usually heal well in a cast.
Surgery may be performed as an emergency or electively within days of the injury. Standard pre-assessment and fasting are required. Inform the team about all medications and allergies.
The aim is to restore the normal alignment and stability of the wrist, reduce pain, and allow earlier and more predictable rehabilitation. Most patients achieve good function and return to normal activities.
Wrist and finger stiffness is common after fractures. Early movement and hand therapy help.
Expected around the wrist for several weeks.
The incision may be sensitive initially.
The plate may be palpable under the thin skin of the wrist. Removal is occasionally needed.
Tendons running over the plate can become irritated. Rupture of the extensor pollicis longus tendon is an uncommon but recognised risk.
The median nerve may be compressed during the injury or irritated during surgery. Carpal tunnel symptoms may develop.
Wound infection, usually treated with antibiotics.
The bone may heal in an imperfect position or fail to heal.
Chronic pain and stiffness affecting the hand and wrist.
Usually performed under general anaesthesia or regional arm block. Local anaesthesia is possible for some patients.
A splint or cast is worn for two to six weeks depending on the fixation. Finger exercises begin immediately. Wrist exercises start once the splint is removed. Hand therapy helps restore movement and strength. Most patients return to desk work within two to three weeks and to manual work at six to twelve weeks. Driving is usually possible at six weeks. Full recovery takes three to six months.
Wound check and X-ray at two weeks. Further X-rays at six weeks to confirm healing. Hand therapy as directed. The plate is not usually removed unless it causes problems.
Not routinely. Around 5–10% of patients have the plate removed if it causes tendon irritation or discomfort. This is a separate, smaller operation.
Usually at around six weeks, once you can comfortably grip the steering wheel and operate the controls.
Most patients regain good function. Some mild stiffness or aching, particularly in cold weather, is not unusual. Full strength may take several months to return.