From the Guidelines
The recommended treatment for a distal radius fracture typically involves immobilization with a cast or splint for 4-6 weeks, depending on fracture severity and patient factors, with a preference for rigid immobilization over removable splints when using nonsurgical treatment, as suggested by the American Academy of Orthopaedic Surgeons (1).
Key Considerations
- Initial management includes a sugar-tong or volar splint to accommodate swelling, followed by a short or long arm cast once swelling subsides.
- Pain management consists of acetaminophen (500-1000mg every 6 hours) and/or NSAIDs like ibuprofen (400-600mg every 6-8 hours) for mild to moderate pain, with opioid alternatives considered alongside opioid sparing protocols when possible (1).
- For severe pain, short-term opioids such as hydrocodone/acetaminophen (5/325mg every 4-6 hours) may be prescribed for 3-7 days.
- Elevation of the affected limb above heart level and ice application (20 minutes on, 20 minutes off) help reduce swelling and pain.
Immobilization and Follow-Up
- Immobilization is crucial as it maintains bone alignment while the fracture heals.
- Regular follow-up appointments with radiographs are essential to ensure proper bone alignment during healing, although the frequency of radiographic evaluation does not affect outcomes (1).
Rehabilitation
- Physical therapy is typically initiated after cast removal to restore strength and range of motion, with supervised therapy potentially benefiting specific subsets of patients (1).
- A patient-centered discussion is essential to understand an individual patient’s values, preferences, and functional demand to inform appropriate decision-making (1).
From the Research
Treatment for Distal Radius Fracture
- The recommended treatment for a distal radius fracture includes immobilization and pain management 2.
- A nondisplaced, or minimally displaced, distal radius fracture is initially treated with a sugar-tong splint, followed by a short-arm cast for a minimum of three weeks 2.
Immobilization Techniques
- Immobilization in supination with a sugar-tong splint or no restriction of forearm range of motion with a volar splint have similar outcomes in terms of range of motion, grip strength, and patient-rated outcome measures 3.
- A comparison of sugar-tong and volar-dorsal splints for provisional immobilization of distal radius fractures found no significant difference in loss of reduction rates between the two splint groups 4.
Pain Management
- Pain management during rehabilitation after distal radius fracture stabilized with volar locking plate can be achieved with transdermal buprenorphine or codeine/ibuprofen, which can lead to faster functional recovery 5.
- The use of celecoxib, buprenorphine transdermal patch, and codeine plus ibuprofen for pain management during rehabilitation after distal radius fracture has been studied, with transdermal buprenorphine and codeine/ibuprofen showing decreased VAS scores during rehabilitative exercise 5.
Duration of Immobilization
- The optimal duration of cast immobilization for non-displaced distal radial fractures is unclear, with some studies suggesting that three weeks of immobilization may be sufficient 6.
- A randomized trial comparing three weeks vs. five weeks of cast immobilization for non-displaced distal radial fractures found no clear advantage for one treatment option over the other 6.