What are the treatment options for a distal radial (radius) metaphyseal fracture?

From the Guidelines

For a distal radial metaphyseal fracture, treatment should prioritize restoration of radial length, inclination, and tilt, as well as the realignment of the articular fracture fragments, with operative fixation considered for cases with a coronally oriented fracture line, die-punch depression, or more than three articular fracture fragments 1. When managing distal radial metaphyseal fractures, it's crucial to consider the increasing incidence of such fractures, especially in the elderly, due to rising rates of osteoporosis 1. The goal of treatment is to achieve proper alignment and prevent long-term complications like osteoarthritis.

Key Considerations

• Restoration of radial length, inclination, and tilt is essential for successful treatment 1.
• The presence of a coronally oriented fracture line, die-punch depression, or more than three articular fracture fragments are common indications for operative reduction 1.
• Operative fixation should aim to result in less than 2 mm of residual articular surface step-off to avoid long-term complications 1.

Treatment Approach

• Non-displaced fractures may be managed with immobilization using a short arm cast for 4-6 weeks.
• Displaced fractures often require closed reduction followed by casting, and in some cases, surgical fixation with pins, plates, or screws may be necessary.
• Pain management and swelling reduction strategies, such as elevation and ice application, are important adjuncts to the primary treatment.

Follow-Up and Rehabilitation

• Regular follow-up x-rays at 1-2 weeks and then 4-6 weeks are crucial to ensure proper healing.
• Range of motion exercises should commence after cast removal to restore wrist function, highlighting the importance of rehabilitation in the overall treatment plan.

From the Research

Treatment Options for Distal Radial Metaphyseal Fractures

• The use of a percutaneous K-wire to augment the reduction of the fracture in children who have a completely displaced metaphyseal fracture of the distal radius is a safe and reliable way of maintaining alignment of the fracture 2.
• Combining a mini-plate for metaphyseal stabilization with a volar locking plate for overall fracture fixation can enhance the structural stability and radiologic outcomes of metaphyseal comminuted distal radius fractures 3.
• In adolescents, metaphyseal distal radius fractures have a higher risk of early re-displacement when not reduced in theatre; however, both casting and fixation resulted in similar final angulation 4.

Rehabilitation and Immobilization

• There is no single consensus concerning the length of immobilization and type of post-operative physiotherapeutic rehabilitation program for distal radius fractures 5.
• Palmar locking plate fixation represents a very stable fixation of the distal radius, but most authors report additional immobilization after plate fixation 5.
• The need for immobilization and physiotherapy after distal radius fractures is still a topic of debate, with some studies suggesting that early mobilization may be beneficial 5.

Complications and Outcomes

• Complications occurred in 14.3% of adolescents with metaphyseal distal radius fractures, including two cases of osteomyelitis 4.
• Few long-term issues were observed in those treated in cast, even with up to 20° of residual angulation 4.
• The use of a mini-plate for metaphyseal stabilization can simplify the surgical procedure and improve radiologic outcomes 3.