What type of cast is recommended for a mid shaft radius fracture?

Type of Cast for Mid Shaft Radius Fracture

For a mid shaft radius fracture, rigid immobilization with a cast is strongly recommended over removable splints. 1

Initial Immobilization Options

The American Academy of Orthopaedic Surgeons (AAOS) recommends rigid immobilization for displaced fractures, with moderate strength of recommendation 1. This applies to mid shaft radius fractures as well, where proper immobilization is crucial for optimal healing.

For initial immobilization after reduction:

• Sugar-tong splint is appropriate for the initial immobilization period 2
• This should be followed by a short-arm cast for a minimum of three weeks 3

Cast Characteristics and Application

For optimal immobilization of a mid shaft radius fracture:

• The wrist should be positioned in a neutral position 4
• The cast should be well-molded to maintain proper alignment 5
• Immobilization typically continues for approximately 6 weeks total 5

Monitoring During Treatment

Proper follow-up is essential to ensure adequate healing:

• Radiographic follow-up at 1-2 weeks after initial reduction to detect early angulation 5
• Additional follow-up at 3 weeks and at cessation of immobilization 4

Special Considerations

For Combined Fractures

• If both radius and ulna are fractured, surgical correction may be required 3
• Isolated mid shaft radius fractures generally have better outcomes with conservative management than combined fractures

For Displaced Fractures

• Surgical fixation should be considered for fractures with:
  • Postreduction radial shortening >3 mm
  • Dorsal tilt >10°
  • Intra-articular displacement 1, 4

Potential Complications

• Loss of reduction is a risk, particularly in the first 2 weeks of treatment 2
• Inadequate immobilization may lead to malunion or delayed union
• Excessive immobilization may lead to stiffness and reduced range of motion

Rehabilitation

After the immobilization period:

• Progressive range of motion exercises should be initiated 4
• Gradual return to activities as tolerated 4
• Active finger motion exercises should begin immediately following diagnosis to prevent stiffness 4

Common Pitfalls to Avoid

1. Inadequate follow-up imaging: Failure to obtain radiographs at 1-2 weeks may miss early loss of reduction
2. Improper cast application: Poor molding can lead to loss of reduction
3. Prolonged immobilization: Can lead to stiffness and delayed functional recovery
4. Missed associated injuries: Always evaluate for concomitant injuries

By following these guidelines, optimal healing and functional outcomes can be achieved for patients with mid shaft radius fractures.