Distal Radius Fracture Surgery
in Rockhampton

What is going on

Distal radius fracture is the most common upper-limb fracture, with a bimodal distribution — high-energy injuries in young adults (a fall from height, a sports impact, a road-traffic injury) and low-energy fragility fractures in older patients (a fall from standing height). The classic mechanism is a fall on the outstretched hand. A visible 'dinner-fork' wrist deformity is the giveaway when the fracture is displaced; undisplaced patterns are easy to miss without imaging. In older patients a distal radius fracture is often the first sign of underlying osteoporosis, and bone-density assessment is routinely arranged after the injury.

Not sure if this is the right diagnosis? The wrist pain hub triages the differential by anatomical location.

What the operation involves

Open reduction internal fixation through a volar approach (Henry's approach between flexor carpi radialis and the radial artery) places a low-profile locking plate on the volar surface of the distal radius, with locking screws supporting the subchondral bone of the articular surface. Care is taken to keep the distal screw row at least 3 mm proximal to the subchondral bone in comminuted intra-articular patterns — placing screws too close to the joint surface is associated with worsening ulnar variance. Fluoroscopy confirms reduction and screw position; the volar capsule is repaired and the pronator quadratus closed over the plate. The operation typically takes 60 to 90 minutes under regional or general anaesthesia as a day or short-stay case. Full clinical detail is on the education page.

For full clinical detail — incision, anaesthetic, post-operative instructions and the printable patient handout — see the distal radius orif education page or the wrist surgery overview.

How this case is handled

Distal radius fractures are usually first seen in the emergency department or at the GP, where a closed manipulation under haematoma block (or in theatre under sedation) is often done at presentation to reduce gross deformity. The surgical referral comes a few days later when the swelling has settled enough to plan a definitive fixation. The practice triages distal radius referrals within the week to keep the surgical window short. Hand therapy with Ruby Doolan at Extend Rehabilitation is integrated into the post-operative pathway and continues for around 12 weeks. In older patients, bone-density assessment and a referral for osteoporosis management are arranged through the GP after the acute injury settles.

Fees, Medicare rebates and the surgery-quote process are on the fees page. The case for seeing a fellowship-trained surgeon — and what fellowship training adds — is set out separately. GPs can find the referral pathway, urgency triage and what to include in the letter on the referrer page.

What this operation is billed under

The procedure is covered by the following Medicare Benefits Schedule items. Surgeon, anaesthetist, assistant, hospital and prosthesis fees are quoted separately and in writing before surgery — see the fees page for the practice's quote process and an explanation of why surgical fees follow the Australian Medical Association schedule. Surgery does not proceed without itemised written informed financial consent.

Item 47370 Intra-articular ORIF of distal radius

Open reduction with internal fixation when the joint surface is involved — the modal pattern for displaced distal radius fractures

Item 47364 Extra-articular ORIF of distal radius or ulna

Open reduction with internal fixation when the joint surface is not involved

Patient questions we hear most

• My wrist is in a cast — do I need surgery?

  Not necessarily. A well-moulded cast is sufficient for many distal radius fractures — particularly stable, undisplaced patterns in older patients with sedentary lifestyles, and any pattern where the post-reduction imaging shows the fragments in an acceptable position. Surgery is offered when the fragments are displaced past acceptable thresholds, when the pattern is unstable (the fragments slip back into a poor position on serial X-rays through the first two weeks), when the joint surface is stepped, or when the patient is active enough to prefer earlier mobilisation. The decision is individual and is discussed at the consult with the imaging on screen.

• I'm over 70 — does it still make sense to fix my wrist?

  Often, yes. The published evidence on distal radius fixation in older patients has shifted significantly over the last decade: while non-operative management remains a reasonable choice for many low-demand patients, internal fixation in older patients with meaningful displacement shows better grip strength, better range of motion and better DASH scores at one year than casting alone in several large studies. The decision depends on the displacement, the patient's functional demands and their general health. Age alone is not a contraindication to surgery.

• How much does distal radius fracture surgery cost? What does Medicare cover?

  Distal radius ORIF involves separate fees for the surgeon, anaesthetist, hospital and the surgical implant (volar locking plate and screws). The practice quotes the surgical fee in writing before booking — the Medicare item, the rebate and the out-of-pocket gap each shown separately. Dr Hirpara's surgical fees follow the Australian Medical Association schedule, which is higher than the Medicare scheduled fee; the fees page explains why. Surgery does not proceed without itemised written informed financial consent.

• Will I need the plate removed later?

  Usually no. The volar locking plates used in modern distal radius fixation are low-profile, designed to sit under the pronator quadratus muscle, and rarely cause symptoms. Plate removal is considered when the plate is prominent and causing flexor tendon irritation, when there is implant infection (rare), or when the patient is young and elects removal for personal reasons. Most patients keep their hardware for life with no problems. Removal — when done — is a small day-case procedure a year or so after the index operation.

• When can I drive after distal radius ORIF?

  Driving requires a safe grip on the wheel and the ability to manage indicators and gears. With a wrist splint on, driving is not safe and is not recommended. Once the splint is removed — typically at four to six weeks — driving is reasonable when the wrist can grip the wheel firmly, perform an emergency stop without needing to protect the hand, and you are off prescription pain medication. The practice does not certify fitness to drive for insurance purposes — driving fitness is a decision between the patient, the GP and the insurer — but the question is discussed at the post-operative review.

• I had a fragility fracture — should I worry about my bones?

  A distal radius fracture in a patient over 50 from a fall from standing height is often the sentinel sign of underlying osteoporosis. A DEXA scan and a discussion with the GP about bone-health management — vitamin D, calcium, exercise, and medication where indicated — is arranged routinely as part of the post-operative pathway. Treating the underlying bone density is what reduces the risk of the next fracture (most often a hip fracture in this group) — fixing the wrist alone doesn't address the cause.

More general questions about appointments, fees and the practice on the FAQ page.