A radial fracture is a break in the radius, the larger of the two bones in your forearm. It can happen near the wrist, in the middle of the forearm, or at the elbow, and it’s one of the most common bone injuries in adults. The type, location, and severity of the break determine whether you’ll need a cast, surgery, or something in between.
Where the Radius Sits and What It Does
Your forearm has two long bones running side by side: the radius and the ulna. The radius sits on the thumb side. At the top, it connects to your elbow joint, where its rounded head rotates against the upper arm bone. At the bottom, it forms the main connection between your forearm and your wrist, linking up with two small wrist bones called the scaphoid and lunate.
The radius is responsible for a surprising range of movement. It lets you rotate your palm face-up and face-down (the motions you use to turn a doorknob or pour a glass of water). It also plays a role in bending and straightening your elbow, and it allows your wrist to bend, extend, and move side to side. Because the radius is involved in so many everyday actions, a fracture in any part of it tends to be immediately disabling.
Fractures Near the Wrist
The most common location for a radial fracture is the distal end, the part closest to your wrist. This is what most people mean when they hear “broken wrist.” These fractures usually happen when you fall and catch yourself with an outstretched hand. Within this broad category, several named fracture patterns exist based on which direction the bone shifts.
A Colles fracture, first described in 1814, is the most frequent type. The broken fragment tilts upward, toward the back of the hand. On an X-ray, it creates a recognizable shape sometimes called a “dinner fork” deformity because the wrist looks bent like the curve of a fork when viewed from the side. A Smith fracture is essentially the reverse: the broken piece angles toward the palm instead. Barton fractures are more complex because the break extends into the wrist joint itself, with the fragment shifting either forward or backward.
Fractures at the Elbow
At the opposite end of the radius, near the elbow, a break in the rounded top of the bone is called a radial head fracture. These typically happen from the same kind of fall, with force traveling up through the outstretched arm and concentrating at the elbow. Doctors grade these injuries using a system with three levels. A Type 1 fracture is a hairline crack or small chip with no displacement, meaning the pieces haven’t shifted out of position. A Type 2 fracture involves a fragment that has separated, become pressed in, or tilted out of alignment. A Type 3 fracture is the most severe: the entire radial head is broken into multiple pieces.
Radial head fractures can make it difficult or impossible to straighten your elbow or rotate your forearm, since that rounded bone head is what allows smooth rotation at the joint.
Symptoms to Recognize
Pain and limited movement are the hallmark signs. With a distal radius fracture, you’ll typically notice immediate wrist pain that worsens with any attempt to grip or twist. The wrist may look visibly deformed, especially with a displaced Colles fracture. Swelling appears quickly, and you might feel or hear a grating sensation (called crepitus) when the broken ends of bone shift against each other.
With a radial head fracture at the elbow, the pain centers on the outer side of the elbow, and bending or straightening the arm becomes difficult. Swelling can be less dramatic at the elbow than at the wrist, which sometimes leads people to assume they’ve only sprained it.
How It’s Diagnosed
Standard X-rays from three angles (front-to-back, side, and oblique) are the first step and are enough to confirm most radial fractures. Your doctor will look at the alignment of the bone, whether the break extends into a joint surface, and how far the fragments have shifted. A CT scan is occasionally used when the X-rays don’t tell the full story, particularly when a fracture runs into the joint and the surgeon needs to plan an operation, but most cases don’t require additional imaging.
Treatment Without Surgery
If the broken bone hasn’t shifted significantly, or if it can be manually realigned (a process called closed reduction), immobilization with a cast or splint is the standard approach. Depending on the fracture’s stability, this might be a short arm cast covering the forearm and wrist, or a long arm cast that extends above the elbow to limit rotation.
During immobilization, you’ll typically have follow-up X-rays at regular intervals, commonly around one, two, six, and twelve weeks after the injury. These check that the bone fragments haven’t drifted out of alignment as swelling goes down and healing progresses. If the fracture shifts during this window, surgery may become necessary even if it wasn’t the first choice.
When Surgery Is Needed
Surgery becomes the preferred option when the fracture is unstable, displaced, or involves the joint surface. Among orthopedic surgeons, there is strong agreement that a joint surface gap or step-off of 2 millimeters or more in patients younger than 65 is a clear reason for surgical fixation. The same applies to displaced fractures that can’t be adequately realigned by hand in patients younger than 75.
The most common surgical approach involves a metal plate and screws placed along the bone to hold the fragments in proper alignment while they heal. For severe radial head fractures at the elbow (Type 3), the shattered bone head may need to be removed entirely and sometimes replaced with a prosthetic.
Recovery and Rehabilitation
Bone healing for a distal radius fracture generally takes about six weeks, though full recovery of strength and motion stretches well beyond that. After the cast comes off, most people notice significant stiffness and weakness in the wrist and forearm. This is normal and expected.
Rehabilitation focuses on several overlapping goals. Early on, the priority is restoring range of motion through gentle active wrist movements and joint mobilization. Home exercises during this phase center on moving the wrist through its available range without forcing it. As mobility improves, stretching and grip strength exercises are added. Coordination work, such as fine motor tasks and controlled forearm rotation, is introduced as the bone and surrounding tissues tolerate more load. Around 90% of physical therapists prescribe active range-of-motion exercises as the foundation of home programs, with grip strengthening and passive stretching layered on top.
There’s no universally standardized rehabilitation protocol, so your timeline will depend on the fracture type, whether surgery was involved, and how your individual healing progresses. Most people return to desk work and light daily activities within a few weeks of cast removal, while return to physically demanding work or sport can take three to six months.
Possible Complications
Most radial fractures heal without lasting problems, but complications do occur, especially with more severe injuries or those requiring surgery.
- Nerve injury: The median nerve, which runs through the wrist, is the most commonly affected. Nerve symptoms occur in 2 to 8.5% of cases and can range from temporary numbness and tingling in the fingers to acute carpal tunnel syndrome, which requires urgent treatment. Nerve irritation from swelling or bruising usually resolves on its own over weeks.
- Malunion: If the bone heals in an improper position, it can alter the mechanics of the wrist and forearm. Loss of the normal tilt at the end of the radius can limit rotation and lead to instability in the wrist. Over time, this altered alignment may cause arthritis.
- Post-traumatic arthritis: Fractures that extend into the joint surface carry a higher risk of arthritis developing later, particularly when the healed joint surface has a gap or irregularity of 2 millimeters or more. This can affect the wrist joint, the joint between the radius and ulna, or both.
- Tendon problems: After surgical plate fixation, tendons that run close to the hardware can become irritated or, in rare cases, rupture from rubbing against the metal over time.
- Stiffness: Some degree of lost motion, particularly in forearm rotation and wrist flexion, is common even after successful treatment. Consistent rehabilitation is the best way to minimize this.