What is the treatment for an angulated but non-displaced fracture of the radial bone?

Treatment of Angulated Non-Displaced Radial Bone Fracture

For angulated but non-displaced radial bone fractures, treatment with a removable splint or short-arm cast for 3 weeks is recommended, as this provides adequate healing while minimizing functional limitations. 1, 2

Initial Assessment

• Radiographs should be obtained to confirm the diagnosis and evaluate:
  • Degree of angulation
  • Absence of displacement
  • Joint stability
  • Associated injuries
• If radiographs are indeterminate, CT without IV contrast may be necessary to better visualize fracture morphology 1

Treatment Algorithm

1. Immobilization Options

• Primary recommendation: Short-arm cast or removable splint for 3 weeks 1, 2
  • The American Academy of Orthopaedic Surgeons recommends removable splints for minimally displaced fractures 1
  • Research shows 3 weeks of immobilization leads to better functional outcomes compared to 5 weeks (better PRWE and QuickDASH scores) 2

2. Immobilization Technique

• For acute injuries with anticipated swelling, splints are the optimal initial choice 1
• Well-molded plaster casts should be used if converting to a cast after initial swelling subsides 3
• Sugar-tong splint may be used initially, followed by a short-arm cast 3

3. Rehabilitation Protocol

• Begin active motion exercises immediately after the immobilization period 1
• Apply ice during the first 3-5 days for symptomatic relief 1
• Progressive range of motion exercises should follow immobilization 1
• Consider a directed home exercise program after immobilization 1

4. Follow-up Schedule

• Radiographic follow-up at 3 weeks (at cessation of immobilization) 1
• Additional follow-up may be needed until union is confirmed (approximately 90% of fractures unite within 12 weeks) 1

Special Considerations

Age-Specific Factors

• Children: Have higher tolerance for immobilization and faster healing rates 1, 4

  • For children under 9 years, up to 15 degrees of angulation is acceptable 4
  • For children 9 years or older, 10-15 degrees of angulation is acceptable depending on fracture location 4

• Elderly patients:

  • Evaluate for osteoporosis risk 1
  • Consider calcium and vitamin D supplementation 1
  • Assess fall risk factors 1

Complications to Monitor

• Secondary displacement (rare in non-displaced fractures) 2, 5
• Chronic pain, joint stiffness, muscle atrophy with excessive immobilization 1
• Median nerve injury (particularly with distal radius fractures) 3

Important Caveats

• Avoid low-intensity pulsed ultrasonography (LIPUS) as it does not accelerate healing or lower rates of nonunion 1
• Smoking increases the rate of nonunion and leads to inferior clinical outcomes 1
• Recent research (Cast-OFF trial) suggests that even shorter immobilization periods (1 week) may be feasible for stable distal radius fractures, though this is not yet standard practice 5
• If the fracture appears blue, purple, or pale, emergency services should be activated immediately 1

The evidence strongly supports shorter immobilization periods (3 weeks) over traditional longer periods (5 weeks) for non-displaced radial fractures, as this leads to better functional outcomes without increasing complications 2.