Best Splint for Distal Radial Fracture
For distal radial fractures, rigid immobilization with a cast is preferred over removable splints, as recommended by the American Academy of Orthopaedic Surgeons. 1
Initial Immobilization Options
Non-Surgical Management
Sugar-tong splint: Preferred for initial immobilization before conversion to a short-arm cast
- Provides better control of forearm rotation
- Typically applied with the wrist in a neutral position
- Minimum immobilization period of 3 weeks 1
Volar-dorsal splint: Alternative option for initial immobilization
- Research shows comparable outcomes to sugar-tong splints regarding loss of reduction rates 2
- May be easier to apply in some clinical settings
Post-Surgical Management
- After volar plate fixation:
- Evidence suggests that immobilization in a specific position (e.g., supination) does not result in superior outcomes compared to simple volar splinting 3
- Recent research indicates that immediate mobilization after volar locking plate fixation may provide better early functional outcomes than splinting 4, 5
Factors Influencing Splint Selection
Fracture Characteristics
Displaced fractures:
- Surgical fixation is recommended for fractures with:
- Postreduction radial shortening >3 mm
- Dorsal tilt >10°
- Intra-articular displacement 1
- Rigid immobilization is preferred if managed non-surgically
- Surgical fixation is recommended for fractures with:
Non-displaced/minimally displaced fractures:
- Can be managed with immobilization
- Short-arm cast for minimum of 3 weeks 6
Patient Age Considerations
- For patients >55 years:
- Evidence does not clearly demonstrate difference between casting and surgical fixation 1
- Consider bone quality and functional demands
Rehabilitation Protocol
- Immediate finger motion: Should begin immediately after splinting to prevent stiffness 1
- Wrist motion: Early wrist motion is not routinely needed following stable fracture fixation 1
- Adjuvant treatment: Consider vitamin C supplementation for prevention of disproportionate pain 1
- Ice application: Beneficial during first 3-5 days for symptomatic relief 7
Common Pitfalls to Avoid
- Overdistraction: When using external fixation, limit the duration to reduce complications 1
- Inadequate immobilization: Removable splints may lead to loss of reduction in displaced fractures
- Prolonged immobilization: May lead to stiffness and delayed functional recovery
- Neglecting finger exercises: Can result in unnecessary stiffness even with proper wrist immobilization
Follow-up Protocol
- Radiographic follow-up at 3 weeks and at cessation of immobilization 7
- After immobilization period, progressive range of motion exercises and gradual return to activities are recommended 7
The evidence strongly supports rigid immobilization with a sugar-tong splint as the initial treatment of choice for distal radius fractures requiring non-surgical management, with conversion to a short-arm cast after initial swelling subsides.