From the Guidelines
A sugar-tong splint is recommended for an acute distal radial metadiaphyseal fracture with dorsal angulation. The sugar-tong splint should be applied with the wrist in slight flexion and ulnar deviation to counteract the dorsal angulation of the fracture. The splint should extend from the mid-forearm, around the elbow, and back to the palm of the hand, immobilizing both the wrist and elbow joints. To apply:
- Use padding to protect bony prominences
- Apply the plaster in a U-shape along the dorsal forearm, around the elbow, and along the volar forearm
- Mold the splint carefully to maintain proper alignment
- Secure with an elastic bandage The sugar-tong splint is preferred for this injury because it provides excellent immobilization of the fracture site while allowing for swelling. It prevents rotation of the forearm and maintains the reduction of the fracture. The slight flexion and ulnar deviation position helps counteract the typical dorsal and radial displacement seen in these fractures. Patients should be instructed to keep the arm elevated, move their fingers regularly to prevent stiffness, and return for follow-up in 5-7 days for reassessment and possible transition to a cast if swelling has subsided. This recommendation is based on the most recent and highest quality evidence available, including the 2022 American Academy of Orthopaedic Surgeons/American Society for Surgery of the Hand clinical practice guideline summary management of distal radius fractures 1.
From the Research
Type of Splint for Acute Distal Radial Metadiaphyseal Fracture
The type of splint indicated for an acute distal radial metadiaphyseal fracture with dorsal angulation is not explicitly stated in the provided studies. However, the studies discuss various treatment options for distal radial fractures, including:
- Volar locking plates: Studies 2, 3 discuss the use of volar locking plates for metaphyseal-diaphyseal fractures of the distal radius, which can provide stable fixation of the distal fragments while allowing for standard plate fixation in the proximal radius.
- Distraction plates: Studies 4, 5 describe the use of distraction plates for distal radial fractures with metaphyseal and diaphyseal comminution, which can help maintain distraction across the radiocarpal joint and stabilize the diaphysis.
- Casting: Study 6 mentions the use of casting for conservative treatment of distal radius fractures, but does not specifically address the type of splint used for acute distal radial metadiaphyseal fractures with dorsal angulation.
Key Considerations
When treating an acute distal radial metadiaphyseal fracture with dorsal angulation, the following key considerations should be taken into account:
- Anatomic reduction: Achieving anatomic reduction of the fracture is crucial to prevent long-term complications and promote proper healing 2, 4, 3, 5.
- Stable fixation: Providing stable fixation of the distal fragments is essential to allow for early mobilization and prevent further displacement of the fracture 2, 4, 3, 5.
- Maintenance of radial bow and interosseous space: Maintaining the radial bow and interosseous space is important to prevent long-term complications and promote proper healing 2, 4, 3, 5.