From the Guidelines
A suspected distal fracture should be immediately evaluated with radiography as the initial imaging modality of choice, with a 3-view examination of the affected area, such as a posteroanterior (PA), lateral, and oblique view, to confirm the diagnosis and guide treatment. The symptoms of a distal fracture typically include pain, swelling, bruising, deformity, and limited movement in the affected area, most commonly in the wrist, ankle, or fingers 1. Immediate treatment involves the RICE protocol: rest the injured area, apply ice for 15-20 minutes every 2-3 hours, compress with an elastic bandage, and elevate the limb above heart level to reduce swelling. Pain management can include acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) if not contraindicated.
Definitive treatment depends on the fracture's severity and location but may include:
- Immobilization with a cast or splint for 4-8 weeks
- Surgical intervention with pins, plates, or screws for displaced fractures Physical therapy is often recommended after immobilization to restore strength and range of motion. Distal fractures require proper treatment to prevent complications like malunion, arthritis, or chronic pain, as these areas are crucial for joint function and often have complex anatomical structures with multiple small bones and ligaments 1. If radiographs are nondiagnostic, MRI or CT without IV contrast may be used as an alternative to identify radiographically occult acute fractures or stress fractures 1.
Some key points to consider in the treatment of distal fractures include:
- The use of radiography as the initial imaging modality of choice
- The importance of immobilization and pain management in the acute phase
- The need for surgical intervention in cases of displaced fractures
- The role of physical therapy in restoring strength and range of motion after immobilization
- The potential for complications like malunion, arthritis, or chronic pain if proper treatment is not provided.
From the Research
Symptoms of a Distal Fracture
- Stress pain and aching at rest after training 2
- Local palpation pain and edema 2
- Tender resistance 2
- Radiographs may not be positive until 2 weeks after the onset of symptoms 2
Treatment Options for a Distal Fracture
- Early identification of the symptoms 2
- Early diagnosis 2
- A sufficiently long training pause 2
- Consultation of experts in the field 2
- Surgical treatment may be needed in some cases 2
- Pain management with acetaminophen, which has been shown to be noninferior to combination therapy with acetaminophen and tramadol 3
- Avoidance of certain medications, such as celecoxib, which may impair fracture healing 4
Pain Management for a Distal Fracture
- Acetaminophen is a suitable option for pain relief, with a similar efficacy to morphine sulfate but a better safety profile 5
- Combination therapy with oral oxycodone and intravenous acetaminophen may also be effective, but with a less desirable safety profile 5
- Tramadol may be associated with more side effects and is potentially habit-forming, making acetaminophen a preferred choice 3