From the Guidelines
For an incomplete fracture of the distal radial metaphysis with dorsal angulation, a removable splint is the recommended initial immobilization method, as it allows for flexibility and adjustment while maintaining support for the fracture. This recommendation is based on the study by 1, which suggests that removable splints are an option for treating minimally displaced distal radius fractures.
Key Considerations
- The choice of splint should prioritize immobilization of the wrist and forearm while allowing for some degree of flexibility and adjustment.
- A removable splint can be applied with the wrist in a position that counteracts the dorsal angulation of the fracture, typically in slight flexion and ulnar deviation.
- Immobilization typically lasts for several weeks, with regular radiographic follow-up to ensure proper alignment is maintained.
- Pain management should include acetaminophen or NSAIDs as needed, with elevation of the extremity above heart level for the first 48-72 hours to minimize swelling.
Immobilization and Follow-Up
- The removable splint should be worn for 3-4 weeks for children and 4-6 weeks for adults, with regular follow-up appointments to assess fracture alignment and adjust the splint as needed.
- If significant displacement occurs during follow-up, conversion to surgical fixation may be necessary.
- The use of a removable splint allows for easier monitoring and adjustment of the fracture alignment, reducing the risk of complications and promoting optimal healing.
From the Research
Types of Splints for Incomplete Fracture Distal Radial Metaphysis with Dorsal Angulation
- The type of splint used for incomplete fracture distal radial metaphysis with dorsal angulation can vary, with options including sugar-tong splints and volar-dorsal splints 2, 3.
- Sugar-tong splints have been shown to be effective in maintaining reduction in pediatric distal radius fractures, with a study finding that reduction was maintained without more aggressive intervention in 96% of cases 4.
- In adults, a comparison of sugar-tong and volar-dorsal splints found no significant difference in loss of reduction rates between the two splint groups, suggesting that sugar-tong splints may be a suitable option for immobilization 3.
- Another study found that a single sugar-tong splint showed similar efficacy to a long-arm cast in the non-operative treatment of distal radius fractures in the elderly, with no statistically significant differences detected in most radiological parameters 5.
- The choice of splint may depend on various factors, including the location and severity of the fracture, as well as patient demographics and preferences 6, 3.
Key Findings
- Sugar-tong splints have been shown to be effective in maintaining reduction in pediatric distal radius fractures 4.
- No significant difference in loss of reduction rates was found between sugar-tong and volar-dorsal splints in adults 3.
- A single sugar-tong splint was found to be as effective as a long-arm cast in the non-operative treatment of distal radius fractures in the elderly 5.
- The choice of splint should be based on individual patient needs and circumstances 2, 6, 3.