Shattered Distal Radius

Hi Pam,

I can sympathise with you as I have gone through a similar thing just over 4 weeks ago. I broke my distal radius in 4 places into the joint and the ulnar styloid too when I tripped up on an uneven bit of pavement and fell heavily on my left arm. I too had surgery to pin and plate the distal radius and have been wearing a splint since - no plaster.  I'm supposed to start weaning myself off it over the next two weeks - scary! 

Tomorrow I'm seeing a physio for the first time who is a hand specialist so I hope she can help me to mobilise my wrist and hand. Luckily I don't have a problem straightening my fingers but making a fist with a swollen hand isn't easy. My wrist is very immobile - I can't turn my hand to look at my palm or bend my wrist forwards or back more than about 20% of what it should be. The palm of my hand and base of the thumb has a large numb area which is undoubtedly nerve damage from the surgery. I don't like using my hand because it feels so peculiar and I'm still getting a lot of discomfort when I move my arm around, so I tend to keep it awkwardly at waist height not doing much which isn't helping matters.  Doctor told me it will take a year to get range of movement back to pre-fracture, and then it won't ever be as good as it was. 

I can understand how you're worried about your fingers not straightening - has this got worse over the 12 weeks since your surgery? I think I would see my GP in the same circumstances to get some reassurance. Good luck with your recovery - I'll be interested to hear how you're getting on.

Hi Pam , I also had a cycling accident and have a titanium plate held in place with 10 screws. Snapped my hand clean off. I was cycling again after 6 weeks just 30 mile rides to start with. It has now been 5 months since my accident and I am about 98% pre accident condition , almost all movement has returned, enough to do press ups. I actually still have more movement in my damaged wrist than my wife does in her wrists! I do not suffer any stiffness what so ever, just little pulls. Really if I didn't know I had snapped it off I could not tell. It is hard to imagine now what it was like when it was stiff with limited movement. I have cycled 8 , 100mile rides since it was fixed with no ill effects. You have to try and use as normal , brushing my teeth and combing my hair was a challenge and it hurt. After 3 weeks I really bent it over with all of my strength time after time as the physio had shown me. I found that this would drain me the next day ,but the difference in free movement just kept me trying harder. I must admit by 12 weeks I was quite near normal again

Hi Sally I know you don't feel like using your hand but you must , not using it is the worst thing. I know that it feels as though it wants to snap but you really need to work it. Try gently brushing your teeth or combing your hair I know it is difficult and painful but my physio had me back on my bike 6 weeks after I got a plate and 10 screws now 5 months on and I am about 98% , no problems what so ever unrestricted and  pain free.

Hi Paul

I was surprised to read your reply to Sally, particularly re. cycling. My injury was a simpler distal radius fracture with just 1 break (minimal displacement with just plaster, nor surgery). My pain and lack of movement has been mild from the beginning. I  have been out of plaster for nearly 3 weeks and can do most things without too much trouble (eg. lifiting a kettle or  a small bag of shopping). However the hospital doctor warned me not to treat it as normal yet and and not to assume straight away that i could do everything. I was advised to allow another 6 weeks or so after plaster removal to complete recovery. I can bend the hand at the wrist and rotate the arm/hand (palm up or down) at the wrist but still have slight discomfort. I wasn't referred to a physio.

Hi katejo

Yep, I was initially told my wrist was permanently damaged and it would be 6 months before I would be able to ride my bike again. I was told I would have permanent limited stiff movement upon recovery. Such was my injury two surgeons were wanting to perform the operation. Both more optimistic about my prospects than the consultant.The morning after the operation in which I had a titanium plate fitted in place with 7 screws into my hand and 3 up my arm I was able to cross my fingers , managed to dress myself even fastening my shoe laces. It was my right wrist and I am right handed. I must admit that once I found out I had snapped my hand off I hoped they would have to operate as they can align the bones better and as it is secure you can use it quickly. I was in plaster for 2 weeks then a brace which I was told only to wear when out in crowded places and not lift a full kettle for 6 weeks.A week later I saw the physio who was impressed with the work done on my wrist, he the proceeded to roll up his sleeves and told me that he was going to move it and not to worry as he would not be strong enough to damage the titanium plate and wow did he move it , proper pain but it felt great ! I was so happy to see my wrist move again! He told me to go home and do the same and that I would hear and feel it crack but this was just tissue that needed to be broke down. Well I never heard or felt anything really and I did give it plenty of hammer. One thing of note a good blood supply is needed for recovery and when prepping me for the operation the anesatist commented that I had 2 Main arterys going into my arm instead of one, he was quite surprised and took a screen capture for lecturing purposes!  After my second visit to the physio 6 weeks post op. he told me to get back on my bike but stick to short rides of 20 miles , I asked him if 50 was Ok ,he told me my wrist would take it but I probably suffer swelling for a couple of days. So I did 30miles the next day ( with my sports brace on) and was OK but I was worn out the next day. Since my op I have now done 8 , 100 mile ride without problem. Averaging 100 to 150 miles a week.However if My injury was such that I didn't need a plate fitted I would not have been mobile as quickly and I could have done more damage as there would have been nothing keeping my fracture in place. As with your injury if you treated it like I treated mine with a plate in you would have done a lot of damage to yourself. Recovery does seem longer without a plate and I have been told that this is due to the length of time the joint is immobile.

Hi Paul, my goodness you must be the bionic man!  You say you snapped your hand - did you break your distal radius alone or the ulna bone as well? Your recovery sounds nothing short of astonishing. I guess you have a few big pluses on your side besides a steely determination and high pain threshold .. you're undoubtedly a good few years younger than me, and very fit, strong and physically active, so that gives you a good start on the path to healing. It's great to hear that you got back to 98% flexibility in such a short space of time, although it sounds like a brutal regime was needed to get things moving.  Your right wrist too - I guess that makes you push yourself harder when it's the hand that needs to do most of the work.

I was about to buy a new bike the day I fell and broke my wrist and I'm now thinking of selling the bike I do have because of the fracture, as I can't imagine it being possible to ride again. Your story gives me some hope.

i had my first physio visit today and a programme of exercises. Some I can do without too much difficulty like stretching fingers and making a fist, but trying to rotate my wrist to turn my hand from facing down to palm upwards is the worst of the bunch and 4 weeks post op I can barely move it. It's hard to imagine that I will ever be able to achieve at this moment in time. 

Did you lose any sensation in your hand and if so, has it improved now? I'm hoping I don't start to have carpel tunnel as I have a few tingly feelings occasionally in a couple of my fingers. I hope it could just be the swelling causing nerve irritation. 

Thank you for telling your story and your advice re exercising and using the wrist as much as I can. I just need to grit my teeth and get on with the programme! 

Hi Sally, I am not as young as I would like to be! Now I am closer to 39 than 38! When I crashed I was descending at speed I had just slowed to 40mph from 56 according to my gps when it all went awry! I landed in the grass verge next to a rather sturdy dry stone wall in pristine condition , apart from my wrist. I feel exeptionally lucky to walk away from such an accident. I can tolerate pain rather well and in A&E got my hand jigged into place with local  anaesthetic , declining morphine. It took 2 doctors and a nurse to get my hand somewhere near. Weirdly I wanted to experience the pain out of curiosity, to see if I could stand it! As a first aider I was able to recognise that after such an eventful day that on the night I did indeed go into shock as I went to bed, so very cold! However I must admit after the cast was removed and I took the brace off to twist my wrist , that was the worst pain I have experienced in my life. I commented to my boss that if I didn't want to ride my bike so much I would gladly never move my wrist again! I would go and sit on one of my bikes and try to hold the handle bars bemused that I couldn't , trying to work out how I would ever be able to again. As I ride motorcycles as well this was deverstating, so I turned to research, MotoGP riders seemed to be plated and back riding again. I decided I would be no different and ordered a new cycle ahem £6k worth convincing my wife that this was the best form of motivation! I would be lying if I said I didn't doubt that I would be able to ride it once it had arrived from Italy. I was scared stiff that I had lost the movement I required , looking back now I can not imagine the limited to no movement I had. I do remember at about 5 or 6 weeks post op every day it just got a little better day by day. I remember I would try and brush my teeth and this was so hard as was combing my hair however I used these tasks to gauge my progress, a little easier a little less pain.I do not know what exactly I broke however A&E said it was the worst they had seen!  I was told by my surgeon that it hadn't damage the joint though,that I had snapped it off before ,when I had my last consultation with him he told me not to expect arthritis. I remember that my palm was numb for weeks and couldn't stand the cuff of jumpers or coats on my wrist. I think where my plate is it is still numb but to be honest I can not bring myself to touch it. How weird is that I do not mind to twist it -abuse it - feel the joint pain but touching my skin is a no no ! On thing I did was to sleep with my hand elevated for 6 weeks as I was advised , I believe that despite begin tedious this helped greatly. Just thinking after my first visit to physio when I set about bending my wrist 15 minutes a time, the day after I was exhausted and could barely lift my limbs this I think was through the pain of the previous day. I just had to make it hurt a little moe with every rep. My OCD kicking in ! The same after cycling 30miles enjoyable, the day after drained. It was so very difficult to convince myself that it would be OK. Now I am back to my 100 mile rides and I wish that my bum was as comfortable as my wrist over that distance! I do like to challenge myself and boy was this a challenge, the uncertainty was the worst. I did get swelling related tingly feelings and my skin was tight at my fingertips much like wearing a small glove. Light  exercise to raise your heart rate will also aid recovery. Good protein like nuts helps ,a little cheese , green tea (anti oxidants ) all helps, luckily with my cycling my diet helped a lot. Your food builds your body.I do hope my story gives you a little comfort and hope as I know it is an unwelcome voyage into the unknown.

Interesting! i would have thought that the benefits of the surgery (compared to just plaster) would be outweighed partially by additional ligament/tissue damage which would not happen as much in a simple fracture like mine caused by a lower level of force. In my case there was no suggestion of permanent damage at all. I have been pleasantly surprised by the pain levels right from the start. I haven't needed painkillers at all. I remember the first day when i was waiting for my temporary cast to be done. A young doctor or possibly a nurse waked past me and said "Don't worry as it won't hurt once you have the plaster on" but it wasn't actually hurting much then. i was just trying not to move it too much. Later i thought that it would hurt again once the plaster was off. It did slightly but not enough to cause any real problems. If I flex the hand or rotate the arm, i get twinges on the little finger side but can do it. Still have minor swelling if i compare it with the other wrist and slightly tender to squeeze. I would say that  I have around 85-90% flexibility but don't know how long it will take before I can do it without any discomfort.

Mine is also the right hand one so it has been harder to avoid using it. I am quite a bit older than you (52).

Wow, you were certainly fortunate not to have come off a lot worse given the speed you were going when you came off your bike Paul! You're obviously used to putting your body through its paces riding the distances you cover and your high pain threshold certainly figures. Interestingly when I first looked for accounts of fractures on the net one of the first sites I found was a mountain biking forum and I was amazed at what I read written by guys who were back on their bikes and riding serious distances again within weeks - you were probably one of them! 

As for me, I'm 57 so a good few years older. Today my my pain seems to be diminishing at long last so I think the exercises prescribed by the physio are helping things along. I have a lesion on the bony outer part of wrist and that's probably more painful than anything else right now. My hand and forearm are still swelling up but today I went to work without my wrist brace for the first time and survived! I sleep with my arm on a pillow every night so keeping it well elevated overnight. I have a follow-up at the hospital on 13/10 at which point I expect I'll be x-rayed again to see how the bones are healing. I hope I'll get to see my before & after x-ray's and be able to take a photo on my mobile. 

Your recovery story is certainly an inspiring one and it's great that you haven't lost any of your passion for bikes and riding as a result of your injury. Stay safe! 

Today I saw my x-rays for the first time, courtesy of my physio who managed to get them from the hospital. Eek!  it's hard to believe that a trip on a paving stone could cause so much damage leaving me with a comminuted fracture of the distal radius intra articular (into the joint) with nasty sharp pieces visible, the ulna pushed right out of position by a broken section of the distal radius and the outer corner of it broken away and floating about. I certainly made a job of it.

in 3 days time it will have been six weeks since the fracture happened. For the last week I've stopped wearing my splint all the time as I have to start weaning myself off it. Some days are better than others and I'm still taking painkillers from time to time. The swelling of my hand has improved quite a lot but I still have numbness in my palm and around the base of my thumb which makes it feels very weird, like I have a big plaster stuck on it, but of course there's nothing there. I hope I get more sensation back eventually but it may have a long wait. The range of movement in my fingers is pretty good except for my thumb which still has a way to go to get the strength and flexibility back. The wrist movements are another story - it feels as if I have a steel cuff around my wrist! Today was the second visit from my physio (having to pay privately as nothing forthcoming from the NHS yet) and she tried to mobilise my wrist to get more rotational movement. Ouch! At the moment I really struggle to turn my hand so the palm is facing up. Starting with the thumb facing towards me it feels totally impossible to rotate it more than about 20 degrees. I have to keep pushing it because this is the most important movement to get back. It seems like progress is very slow but each week small things such as trying to hold something are getting a little easier.  Not sure about driving though. I'm thinking that I may need to change my manual car for an automatic with an electronic brake to avoid trouble (left hand fracture).  

Hi Ian

I can only give you limited advice as my wrist fracture was not the same type as yours but just want to give some encouragement. I had an xray on the day and then again a week later and another about 2 or 3 weeks after that. Then i was told that the plaster would be removed after 6 weeks in total. Mine was just a simple single radius fracture with minimal displacement. While reading this discussion, i came across others who had more serious sounding fractures but whose plaster was removed after 4 weeks and replaced with a wrist support which could be removed to allow a shower or exercises. I was disappointed that mine wasn't removed in this way so I asked the doctor why. He explained that my local hospital wasn't a research centre for fractures so they didn't have the additional knowledge relating to wrist supports and preferred to stick to the 6 weeks in plaster.

You can start to do some mobility exercises now. Just google 'wrist fracture exercises' and you will get links provided by physio depts. at several hospitals. I started as early as i could.

I can't help re. driving as i don't drive.

Good luck!

Hi Ian,

I've posted previously so you can see my earlier experiences with a bad comminuted fracture of the distal radius and ulna that was fixed with a plate and 8 screws. It happened at the end of August last year and my recovery has gradual but I'm getting there.  I didn't at any point have a cast, only a backslab because the plate was doing the job of a cast I was told by the doctor. The benefit of a backslab is that the wrist can be mobilised much earlier than it would if it was put in a cast. When my stitches were taken out two weeks after surgery and the padded bandages protecting my wrist were changed to a simple stockinette dressing the pain really started - before that I got away with it lightly. It was agony for at least three weeks and then started to ease off gradually. 

Normally xRays are done at the six weeks point as that's the average time for a fracture to knit. I have had three in total at different stages as my fracture wasn't healing very quickly. It's improved a lot in the last month and I have been driving my manual car since mid December. Before that there was no way I could manage gear changes or pulling on the handbrake! I can now type as well but that took about as long as getting back to driving.  Typing was much the same. I can now type with both hands but initially it was impossible as the ulnar area was too painful.

Exercise is essential to speed up recovery.  I had to find myself a hand physio who has been a great help.  I wasn't offered any physio on the NHS. The hand therapist feels that the post fracture position of my hand/wrist isn't quite right, although the surgeons tell me they're happy with it so I'm getting a totally unbiassed second opinion from a specialist hand surgeon in a couple of weeks to see whether he agrees that it's better to leave it alone or try to improve it with revision surgery. I really don't fancy going all through the same thing again!

Good luck with your recovery which I'm sure will be more rapid than mine.

Thanks Kate much appreciated- I have started what exercises I can. There is obviously some pain but I do feel in a better position now then post op. It tends to be the cast that is holding me back now in terms of movement.

Another 3 weeks before cast and kwires are removed. I cant wait for that but also realise that pain will follow out of cast. I have arranged physio shortly after as I need to get movement and strength back as quickly but as sensibly as possible.

I do have some other worries - I have trouble sleeping now which I think is anxiety building about the break not healing.

I do most things right - I dont smoke / have not drank alcohol since the break and my diet is good. I am also reasonably fit as a triathlete and have been on my bike (indoor trainer) several times post op. The main thing holding me back on that is the cast being uncomfortable if I get too hot.

Even so since tve break I seem to worry perhaps needlessly that i will not heal!

Thank you for the reply Sally - I have 3 xrays so far - the day it happened, a week later before 3k wires were inserted and then again last week (2 weeks post op).

Last week seemed much cleaner but as in my other reply I still worry about it and have trouble sleeping.

I have begun exercises and my finger movement is not too bad compared to what other folks have reported.

I have also arranged my own physio for when i am out of the cast - a physio I trust and knows my work and sports background. He will push me but within sensible and safe limits.

So 3 weeks and I will hopefully be happier and cast / wire free (it really frustrates me at night I just want to rip it off).

I am expecting pain again when out of cast but I am being positive that that will be the beginning of the last part of recovery.

Advice from those who have been there is welcome however!!

Thank you

Hi Ian

you may find that the post plaster pain isn't as bad as you had expected. Everyone told me that it would be worse but it was really ok. I didn't need painkillers with the plaster on and i kept off them afterwards too. There was minor discomfort but i just used a wrist support (bought from Boots) to protect it a bit for a month or so and also to remind myself not to pick up heavy bags for the next 6 weeks or so.

Thank you! Hopiymine is similar.

I had to return to the plaster room yesterday as the cast was becoming uncomfortable and it felt like the wires were digging into it / catching.

They cut a small window rather then remove the whole cast to access the wires and redressed them. Feels a lot better now.

Less then 3 weels until the cast is off all being well!!

Obviously I can't be sure about what I said as mine was a simple fracture without wires but fingers crossed..... 

I can only hope!!