What is the management of a distal radius (DR) fracture?

From the Guidelines

The management of a distal radius fracture should prioritize restoration of radial length, inclination, and tilt, as well as the realignment of the articular fracture fragments, with treatment options including immobilization with a cast or splint for stable, non-displaced fractures, and surgical intervention with open reduction and internal fixation for unstable or displaced fractures, as recommended by the American Academy of Orthopaedic Surgeons and the American Society for Surgery of the Hand 1.

Key Considerations

• The treatment approach depends on the stability and displacement of the fracture, with stable, non-displaced fractures typically managed with immobilization and unstable or displaced fractures requiring surgical intervention.
• Pain management is crucial and may include NSAIDs like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) 1.
• Physical therapy should begin after immobilization to restore range of motion and strength, typically 2-3 sessions per week for 4-6 weeks, and early finger movement during immobilization can help prevent stiffness.
• Regular follow-up with radiographs at 1,2, and 6 weeks is essential to ensure proper healing and monitor for complications such as malunion, complex regional pain syndrome, and tendon rupture.

Treatment Options

• Immobilization with a cast or splint for 4-6 weeks for stable, non-displaced fractures, with the wrist positioned in slight flexion and ulnar deviation to maintain proper alignment.
• Surgical intervention with open reduction and internal fixation using plates and screws for unstable or displaced fractures, with a splint applied for 1-2 weeks post-surgery, followed by a removable brace.

Guideline Recommendations

• The American Academy of Orthopaedic Surgeons and the American Society for Surgery of the Hand recommend considering opioid alternatives, such as local anesthetics, nonsteroidal anti-inflammatory agents, and acetaminophen, alongside opioid-sparing protocols when possible 1.
• A strong recommendation is made for operative treatment based on high-quality evidence, while moderate and limited recommendations are made for other aspects of treatment due to varying levels of evidence quality 1.

From the Research

Management of Distal Radius Fractures

The management of distal radius fractures can be divided into non-operative and surgical methods.

• Non-operative management is suitable for select patients, particularly older adults, and involves immobilization with or without reduction 2.
• Surgical management options include:
  • Closed reduction and application of a cast
  • Percutaneous K-wires
  • Open reduction and internal fixation with plates
  • External fixation 2, 3, 4

Treatment Considerations

When deciding on a treatment plan, considerations should include:

• Severity of the fracture
• Desired functional outcome
• Patient comorbidities 2
• Fracture geometry, with certain types (e.g. AO23A) potentially having poorer outcomes 4

Post-Treatment Care

• Patients should be encouraged to mobilize as soon as it is safe to do so to prevent stiffness 2
• Complications such as median nerve compression, tendon rupture, arthrosis, and malunion should be monitored 2

Guideline Recommendations

Current guidelines from various organizations, including the British Orthopaedic Association and the American Academy of Orthopaedic Surgeons, provide recommendations for the management of distal radius fractures 3, 5.

• These guidelines emphasize the importance of individualizing treatment plans to each patient's specific needs and circumstances 5