Radius and Ulna Fractures at the Wrist: Treatment and Recovery

By Your Health Magazine Health Information Team

A radius and ulna wrist fracture means one or both forearm bones have broken near the wrist. Treatment may involve a splint or cast, repositioning the bones without surgery, or surgery with plates, screws, pins, or an external frame. The best approach depends on the fracture’s alignment and stability, whether it extends into the joint, and whether nerves, blood vessels, ligaments, or skin are injured.

What This Injury Involves

The radius and ulna are the two long bones of the forearm. The radius is on the thumb side and forms much of the wrist joint. The ulna is on the little-finger side and works with the radius to support wrist stability and forearm rotation. This relationship is explained further in this overview of the structure and function of the radius and ulna.

Most fractures described as a “broken wrist” are distal radius fractures. The ulna may also break near its end or at the ulnar styloid, the small bony projection on the outside of the wrist. An associated ulnar styloid fracture does not automatically require separate surgery. Its treatment depends partly on whether the joint between the radius and ulna remains stable.

A fracture of the radius and ulna at the wrist commonly follows a fall onto an outstretched hand. High-energy injuries, such as motor vehicle, bicycle, or sports accidents, may produce more complex breaks. In older adults or people with osteoporosis, a fall from standing height may be enough to cause a fracture.

How the Fracture Is Evaluated

Common symptoms include immediate pain, swelling, bruising, tenderness, difficulty moving the wrist, and reduced grip strength. A displaced fracture may make the wrist appear bent or out of position. Numbness, tingling, pale fingers, or weakness can indicate pressure on a nerve or reduced blood flow and require urgent evaluation.

X-rays usually confirm the diagnosis and show whether the bone fragments have shifted. The report may use terms such as:

Nondisplaced: The broken pieces remain in acceptable alignment.
Displaced: The pieces have shifted out of position.
Comminuted: The bone has broken into several fragments.
Intra-articular: The fracture extends into the wrist joint surface.
Open: A wound communicates with the fracture, increasing infection risk.

A computed tomography scan may be ordered when the fracture is complex, involves the joint, or requires detailed surgical planning. The examination should also assess finger circulation and sensation, tendons, wrist ligaments, and the stability of the distal radioulnar joint. The American Academy of Orthopaedic Surgeons’ distal radius fracture guide provides additional information about fracture patterns and evaluation.

Treatment Options

Fracture situation	Common treatment approach
Stable and well aligned	A splint followed by a cast or removable brace, with follow-up examinations and X-rays
Displaced but reducible	Closed reduction to reposition the bones, followed by immobilization and repeat X-rays
Unstable, severely displaced, or joint-involving	Surgery may be recommended to restore alignment and hold the fragments in place
Open fracture or injury affecting circulation or nerves	Urgent specialist treatment, often including surgery and measures to reduce infection or tissue damage

Splinting, Casting, and Closed Reduction

A splint is often used first because it leaves room for swelling. After swelling decreases, a cast may be applied. If the fragments are out of position, a clinician may perform a closed reduction, moving the bones back into alignment without making an incision. Pain control or anesthesia is provided for this procedure.

Repeat X-rays are important because some fractures shift during the first several weeks. A fracture initially treated in a cast may require surgery if it loses alignment.

Surgical Treatment

Surgery is more likely when acceptable alignment cannot be achieved or maintained, the joint surface is significantly disrupted, the fracture is open, or the injury is unstable. Internal fixation commonly uses a plate and screws. Pins or an external fixation frame may be appropriate for certain fracture patterns.

When the ulna is also fractured, the surgeon determines whether it needs separate fixation. A small, stable ulnar styloid fracture may heal or remain symptom-free without an operation. A displaced distal ulna fracture or persistent instability between the radius and ulna may require additional stabilization.

Recovery and Rehabilitation

Recovery time varies with age, bone health, fracture severity, treatment, and the physical demands placed on the wrist. The following is a general guide rather than a fixed schedule:

First several days: Pain and swelling are usually most noticeable. Elevation and wrapped ice packs may help when used as directed.
First several weeks: A splint or cast protects the fracture. Follow-up X-rays may be used to check alignment.
About four to eight weeks: Immobilization may be reduced or removed, depending on healing. Some fractures require protection for longer.
Six to twelve weeks: Bone healing and wrist use generally increase, but heavy lifting may still be restricted.
Around three months and beyond: Many people can resume broader activities after medical clearance. Strength, motion, and comfort may continue improving for up to a year.

Finger movement is often encouraged early to limit swelling and stiffness, but wrist exercises should begin only when the treating clinician approves them. A physical or occupational therapist may help restore wrist motion, grip strength, forearm rotation, and the ability to perform work or household activities.

During recovery, keep the cast or splint dry, do not place objects inside it, and avoid lifting, driving, sports, or weight-bearing through the injured hand until cleared. Pain medicines should be used only as directed, especially if you have kidney disease, liver disease, ulcers, bleeding risks, or take other medications.

Possible Complications and Bone Health

Most wrist fractures heal, but recovery may include prolonged stiffness, weakness, swelling, or aching. Possible complications include healing in an altered position, reduced forearm rotation, instability between the radius and ulna, nerve compression, tendon irritation, infection after an open injury or surgery, and arthritis following damage to the joint surface.

A wrist fracture caused by a minor fall can be an early sign of low bone strength, particularly in middle-aged and older adults. Ask a primary care clinician or orthopedic specialist whether an osteoporosis assessment or bone density test is appropriate. The National Institute of Arthritis and Musculoskeletal and Skin Diseases’ osteoporosis information explains risk factors, testing, and bone-health measures.

When to Seek Care

Seek prompt medical evaluation after a wrist injury if there is substantial pain, swelling, tenderness, deformity, or difficulty using the hand. Go to an emergency department if:

A bone is visible or there is a deep wound near the injury.
The wrist is severely bent or out of position.
The fingers are numb, weak, pale, blue, cold, or difficult to move.
Pain or swelling is severe or rapidly worsening.
A cast feels increasingly tight or causes new tingling or color changes.
There is drainage, a foul odor, fever, or increasing redness after treatment.

An emergency clinician can provide initial stabilization, while an orthopedic surgeon or hand and wrist specialist can determine definitive treatment. For broader government-reviewed health education, visit MedlinePlus health topics. This article provides general education and is not a substitute for an examination or individualized medical advice.