From the Guidelines
The most appropriate splint for a nondisplaced distal radius fracture is a removable splint, as it allows for adequate immobilization while permitting some degree of movement and adjustment for swelling, which is a common occurrence after fracture 1. This type of splint is recommended for minimally displaced distal radius fractures, according to a study published in The Journal of the American Academy of Orthopaedic Surgeons 1.
The use of removable splints is preferred in this context because it provides a balance between immobilization and flexibility, allowing for adjustments as needed to accommodate swelling and promote healing. Key considerations when using a removable splint include:
- Applying the splint with the wrist in a neutral position to avoid excessive extension or flexion
- Ensuring the splint is not too tight to prevent compromising circulation
- Instructing patients to monitor for signs of compartment syndrome, such as increasing pain, paresthesias, pallor, or paralysis
- Advising patients to elevate the affected extremity above heart level and apply ice regularly to reduce swelling
It's worth noting that while another study suggests rigid immobilization for displaced distal radius fractures 1, the question specifically pertains to nondisplaced fractures, making the recommendation for removable splints more applicable 1.
From the Research
Nondisplaced Distal Radius Fractures
- The most appropriate splint for nondisplaced distal radius fractures is a topic of discussion in the provided studies.
- A study from 2 found that a sugar-tong splint is effective in maintaining reductions in pediatric distal radius fractures.
- Another study from 3 compared sugar-tong and volar-dorsal splints for provisional immobilization of distal radius fractures in adults and found no significant difference in loss of reduction rates between the two splint groups.
- A study from 4 compared the effectiveness of a single sugar-tong splint and a long-arm cast in the non-operative treatment of distal radius fractures in the elderly and found that the single sugar-tong splint is as effective as the long-arm cast.
Immobilization Techniques
- The provided studies discuss different immobilization techniques for distal radius fractures, including sugar-tong splints, volar-dorsal splints, and long-arm casts.
- A study from 5 investigated the influence of Kirschner wire fixation and immobilization techniques on radiologic and functional outcomes of distal radius fractures and found that the use of a removable splint improves functional outcomes.
- A review article from 6 outlines the British Orthopaedic Association Standards for Trauma and Orthopaedics for the management of distal radius fractures and emphasizes the importance of considering the severity of the fracture, desired functional outcome, and patient comorbidities when selecting a management approach.
Key Findings
- The sugar-tong splint is a viable option for immobilization of nondisplaced distal radius fractures, particularly in pediatric and elderly populations 2, 4.
- The choice of immobilization technique may depend on the specific patient population and fracture characteristics 3, 5.
- Non-operative management with immobilization can give good results in select patients, especially in older adults 6.