From the Guidelines
Radial fractures should be treated with immobilization for non-displaced fractures, and surgical intervention with internal fixation for displaced fractures, with a focus on patient-centered care and consideration of individual patient values and preferences 1.
Treatment Overview
Treatment of radial fractures depends on the severity and location of the fracture.
- Non-displaced fractures can be treated with immobilization using a cast or splint for 4-6 weeks.
- Displaced fractures often require surgical intervention with internal fixation using plates and screws.
Pain Management
Pain management is crucial in the initial stages of treatment and can include:
- Acetaminophen (500-1000mg every 6 hours)
- NSAIDs like ibuprofen (400-600mg every 6-8 hours) for the first few days
Rehabilitation
Physical therapy is essential after immobilization to restore strength and range of motion, typically starting with gentle exercises and progressing to resistance training.
- Elevation of the arm above heart level and application of ice for 15-20 minutes several times daily helps reduce swelling.
Complications and Follow-up
Complications can include malunion, stiffness, and complex regional pain syndrome, so follow-up with an orthopedic specialist is essential to monitor healing progress 1. Healing time averages 6-8 weeks, though complete functional recovery may take 3-6 months.
Guideline Recommendations
The American Academy of Orthopaedic Surgeons (AAOS) and the American Society for Surgery of the Hand (ASSH) have developed evidence-based clinical practice guidelines for the treatment of distal radius fractures, which include recommendations for operative and non-operative treatment, as well as guidance on rehabilitation and follow-up care 1.
From the Research
Radial Fracture Treatment
- The optimal duration of immobilization for the conservative treatment of non- or minimally displaced and displaced distal radius fractures remains under debate 2.
- A randomized controlled trial found that shortening the period of immobilization in adult patients with a non- or minimally displaced distal radial fractures seems to lead to equal patient-reported outcomes for both the cast immobilization groups 3.
- Studies have shown that shorter immobilization for conservatively treated distal radius fractures often yield equal or better outcomes than longer immobilizations 2, 4.
Immobilization Duration
- A systematic review found that grip strength and patient-reported outcome were better in patients treated by a shorter period of immobilization 4.
- The review also found that there was no difference in pain, range of motion, or radiological outcome between different periods of immobilization 4.
- Another study found that immobilization periods of 1 and 3 weeks produced superior short-term outcomes compared with those after 6 weeks of immobilization 5.
Comparison of Immobilization Methods
- A prospective randomised study compared quality of recovery between brace and traditional cast for immobilisation during the first postoperative week, and found that brace appears to be a feasible option to traditional cast for immobilisation following surgical treatment of DRF 6.
- The study found that the early QoR was similar in both groups apart from more pain in the brace group the first 24 postoperative hours 6.
Recommendations
- Shortening the period of immobilization in distal radial fractures to a maximum of three weeks should be considered 3, 4.
- Future research should include homogeneous groups of patients to draw valid conclusions on the appropriate period of immobilization for nonoperatively treated distal radial fractures 2, 4.