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content is structured, but it still reflects the latest evidence-based guidance.</p><div class="ls-modal__wrapper"><button class="ls-btn primary" onclick="closeDialog()">OK</button><button class="ls-btn secondary" onclick="closeDialog()">Cancel</button></div></dialog><div class="col-md-8 topic-poce"><div id="dates"><div class="row allUpdates"><div class="col-md-4"><span data-test="topic-last-reviewed">Last reviewed: </span><span data-test="topic-last-reviewed-date">23 Jan 2025</span></div><div class="col-md-4"><span data-test="topic-last-updated">Last updated: </span><span data-test="topic-last-updated-date">22 Jun 2023</span></div><div class="col-md-4"></div></div><div class="updatesContent"><div class="collapse" id="impUpdate"><div class="card arrow-card acRight"><div class="card-block"><span class="icon icon-bp-icons-close close" data-test="imp-update-close"></span></div></div></div></div></div><div class="d-flex"><h2 id="sr-only" class="gpw-free">Summary</h2></div><div class="card mb-4"><div class="card-block"><div class="expandable" data-test="topic-summary-expandable"><p class="w-75"><p class="w-75">Wrist fractures affecting the distal radius are the most common fracture in adults and children and are typically caused by a fall on the outstretched hand.</p></p><p class="w-75"><p class="w-75">This injury may be accompanied by fractures of the ulnar styloid, the distal ulna, and the scaphoid. Isolated scaphoid fractures can also occur and should be considered in the differential of a patient with radial-sided wrist pain after a fall on their hand.</p></p><p class="w-75"><p class="w-75">Non-displaced fractures do not have any deformity and are treated with immobilisation in a splint or cast.</p></p><p class="w-75"><p class="w-75">Displaced fractures usually present with a 'dinner fork' deformity and require closed reduction and possible surgical fixation. Successfully reduced fractures can be treated non-surgically with immobilisation and radiographic monitoring.</p></p><p class="w-75"><p class="w-75">Malunion of inadequately reduced fractures may result in decreased range of motion and grip strength, as well as pain, in younger patients, who may place a higher demand on the wrist.</p></p><p class="w-75"><p class="w-75">Purely ligamentous injuries can be a cause of wrist pain after a fall on an outstretched hand in the setting of normal radiographs.</p></p></div><h3 class="pl-0" data-test="topic-summary-def">Definition</h3><div class="expandable" data-test="topic-summary-content"><p class="w-75">Wrist fractures include fractures that affect the distal ends of the radius, ulna, and carpus. Distal radius fractures are one of the most common injuries. The distal radius is defined as the distal one third of the radius. Distal radius fractures may be extra-, intra-, or partial articular and are regularly accompanied with an ulnar styloid fracture.<span class="reference"><a href="#referencePop1" data-trigger="click focus" role="button" data-animation="false" data-toggle="popover" class="referencePop" aria-label="Open reference: 1">[1]</a><span class="citationText" aria-hidden="true">Chen NC, Jupiter JB. Management of distal radial fractures. J Bone Joint Surg Am. 2007 Sep;89(9):2051-62.</span><span class="referenceUniqueId" aria-hidden="true"> http://www.ncbi.nlm.nih.gov/pubmed/17768207?tool=bestpractice.com </span></span><span class="reference"><a href="#referencePop2" data-trigger="click focus" role="button" data-animation="false" data-toggle="popover" class="referencePop" aria-label="Open reference: 2">[2]</a><span class="citationText" aria-hidden="true">Rutgers M, Mudgal CS, Shin R. Combined fractures of the distal radius and scaphoid. J Hand Surg Eur Vol. 2008 Aug;33(4):478-83.</span><span class="referenceUniqueId" aria-hidden="true"> http://www.ncbi.nlm.nih.gov/pubmed/18687836?tool=bestpractice.com </span></span></p><p class="w-75">Fractures associated with a radiographic appearance that is essentially normal with respect to extra- and intra-articular anatomy are considered non-displaced. All other fractures - that is, all fractures with loss of anatomical contours - are considered to be displaced. Clearly, all displacements are not the same and some fractures are associated with greater anatomical deformity than others. Fractures associated with an open wound are considered open fractures.</p></div></div></div><h3>History and exam</h3><div id="histEx" class="card-group mt-3 mb-4 no-shadow"><div class="card"><div class="card-block"><h4 class="card-title x-text-secondary">Key diagnostic factors</h4><ul id="diagFactors" class="list-aligned mb-1" data-test="diag-factors"><li>presence of risk factors</li><li>wrist pain</li><li>tenderness over the distal radius</li><li>swelling</li></ul><div class="fullDetails-disabled mt-2" data-test="full-details-diag-factors"><span>Full details</span></div></div></div><div class="card"><div class="card-block"><h4 class="card-title x-text-secondary">Other diagnostic factors</h4><ul id="otherFactors" class="list-aligned mb-1"><li>deformity</li><li>tenderness in the anatomic snuff-box</li><li>numbness in the fingers</li><li>hypo-aesthesia</li><li>open wound</li></ul><div class="fullDetails-disabled mt-2"><span>Full details</span></div></div></div><div class="card"><div class="card-block"><h4 class="card-title x-text-secondary">Risk factors</h4><ul id="riskFactors" class="list-aligned mb-1"><li>trauma</li><li>osteopenia</li><li>osteoporosis</li></ul><div class="fullDetails-disabled mt-2"><span>Full details</span></div></div></div></div><div class="border-top-light-gray mb-4 d-block locked-banner"><div class="card pt-2 pb-2 shadow-none"><a class="fullDetails-locked d-flex align-items-center justify-content-center" href="/log-in"><img src="/images/padlock-lock.svg" class="mr-2" alt="padlock-locked"><span>Log in or subscribe to access all of BMJ Best Practice</span></a></div></div><h3>Diagnostic investigations</h3><div id="diagInvs" class="card-group mt-3 mb-4 no-shadow"><div class="card"><div class="card-block"><h4 class="card-title x-text-secondary">1st investigations to order</h4><ul id="initialTests" class="list-aligned mb-1"><li>plain x-rays of the wrist</li></ul><div class="fullDetails-disabled mt-2"><span>Full details</span></div></div></div><div class="card"><div class="card-block"><h4 class="card-title x-text-secondary">Investigations to consider</h4><ul id="subTests" class="list-aligned mb-1"><li>CT wrist</li><li>MRI (without contrast) wrist</li></ul><div class="fullDetails-disabled mt-2"><span>Full details</span></div></div></div></div><div class="border-top-light-gray mb-4 d-block locked-banner"><div class="card pt-2 pb-2 shadow-none"><a class="fullDetails-locked d-flex align-items-center justify-content-center" href="/log-in"><img src="/images/padlock-lock.svg" class="mr-2" alt="padlock-locked"><span>Log in or subscribe to access all of BMJ Best Practice</span></a></div></div><h3 class="d-flex align-items-center">Treatment algorithm</h3><div class="card-group mt-3 mb-4 treatment-table topic-page no-shadow" data-test="treatment-table"><div class="card"><div class="card-block p-0"><div class="rowHead" id="acute"><div>ACUTE</div></div><div class="panel-heading bg-white"><h3 class="tx-content"><span>isolated fracture of distal radius</span></h3></div><div class="panel-heading bg-white"><h3 class="tx-content"><span>isolated scaphoid fracture</span></h3></div><div class="panel-heading bg-white"><h3 class="tx-content"><span>concomitant distal radius and scaphoid fractures</span></h3></div><div class="rowHead" id="ongoing"><div>ONGOING </div></div><div class="panel-heading bg-white"><h3 class="tx-content"><span>confirmed wrist fracture</span></h3></div></div></div></div><div class="border-top-light-gray mb-4 d-block locked-banner"><div class="card pt-2 pb-2 shadow-none"><a class="fullDetails-locked d-flex align-items-center justify-content-center" href="/log-in"><img src="/images/padlock-lock.svg" class="mr-2" alt="padlock-locked"><span>Log in or subscribe to access all of BMJ Best Practice</span></a></div></div><h3 data-test="topic-summary-contributors" class="mb-3">Contributors</h3><div><div data-details="wrapper" class="mb-3"><div class="card details-header"><div class="d-flex justify-content-between"><h4 class="card-title card-title--small m-0">Expert advisers</h4><button role="button" class="d-none d-sm-block" data-details="collapsed"><span data-details="text">VIEW ALL</span><span class="sr-only">Expert advisers</span><span class="material-icons" aria-hidden="true"></span></button></div></div><div class="mb-3"><div class="card"><details><summary class="contributors d-flex align-items-center"><h5 class="mb-0">Michael Barrett, MBChB, FRCS (Tr & Orth), PG Cert Med Ed</h5></summary><div class="details-inner"><p class="w-75">Consultant Trauma and Orthopaedic Surgeon</p><p class="w-75">Cambridge University Hospitals NHS Foundation Trust</p><p class="w-75">Cambridge</p><p class="w-75">UK</p><h6 class="font-weight-bold">Disclosures</h6><p>MB is a director of Orthohub.xyz, an online education platform for orthopaedic surgeons. Orthohub.xyz receives sponsorship from the healthcare industry.</p></div></details></div><div class="card"><details><summary class="contributors d-flex align-items-center"><h5 class="mb-0">Acknowledgements</h5></summary><div class="details-inner"><p class="w-75">BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:</p><p class="w-75">Niels W.L. Schep, MD</p><p class="w-75">Trauma, Hand, and Wrist Surgeon</p><p class="w-75">Department of Trauma and Hand Surgery</p><p class="w-75">Maasstad Hospital</p><p class="w-75">Rotterdam</p><p class="w-75">Netherlands</p><h6 class="font-weight-bold">Disclosures</h6><p>NWLS is an author of several references cited in this topic. He is a consultant for Synthes, Medartis, and Arthrex, and has received honoraria from The AO Foundation for teaching courses.</p></div></details></div></div></div></div><div><div data-details="wrapper" class="mb-3"><div class="card details-header"><div class="d-flex justify-content-between"><h4 class="card-title card-title--small m-0">Peer reviewers</h4><button role="button" class="d-none d-sm-block" data-details="collapsed"><span data-details="text">VIEW ALL</span><span class="sr-only">Peer reviewers</span><span class="material-icons" aria-hidden="true"></span></button></div></div><div class="card"><details><summary class="contributors d-flex align-items-center"><h5 class="mb-0">Ramon Tahmassebi, MBBS, BSc (Hons), FRCS (Tr & Orth)</h5></summary><div class="details-inner"><p class="w-75">Consultant Trauma & Orthopaedic Surgeon</p><p class="w-75">Clinical Director Trauma & Orthopaedic Surgery</p><p class="w-75">King's College Hospital NHS Foundation Trust</p><p class="w-75">London</p><p class="w-75">UK</p><h6 class="font-weight-bold">Disclosures</h6><p>RT declares that he has no competing interests.</p></div></details></div></div></div><div><div data-details="wrapper" class="mb-3"><div class="card details-header"><div class="d-flex justify-content-between"><h4 class="card-title card-title--small m-0">Editors</h4><button role="button" class="d-none d-sm-block" data-details="collapsed"><span data-details="text">VIEW ALL</span><span class="sr-only">Editors</span><span class="material-icons" aria-hidden="true"></span></button></div></div><div class="mb-3"><div class="card"><details><summary class="contributors d-flex align-items-center"><h5 class="mb-0">Emma Quigley</h5></summary><div class="details-inner"><p class="w-75">Section Editor, BMJ Best Practice</p><h6 class="font-weight-bold">Disclosures</h6><p>EQ declares that she has no competing interests.</p></div></details></div><div class="card"><details><summary class="contributors d-flex 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