What type of splint is recommended for a distal radial fracture?

Splint Type for Distal Radial Fractures

For distal radius fractures, a sugar-tong splint is the recommended initial immobilization method for acute injuries with anticipated swelling, while rigid immobilization with casts is preferred for displaced fractures. 1

Initial Immobilization Options

Sugar-tong vs. Volar-Dorsal Splints

• Sugar-tong splints and volar-dorsal splints both provide adequate initial immobilization for distal radius fractures 2
• Research comparing these two splint types showed no significant difference in loss of reduction rates between them 2
• The American Academy of Orthopaedic Surgeons recommends:
  • Splints for acute injuries with anticipated swelling
  • Rigid immobilization with casts for displaced fractures 1

Splinting Considerations

• For minimally displaced fractures, removable splints are suitable 1
• For displaced fractures with significant displacement or instability, rigid immobilization or surgical fixation is necessary 1
• Initial splinting should allow for swelling while maintaining fracture alignment

Post-Reduction Management

Active Motion During Immobilization

• Active finger motion exercises should begin immediately following diagnosis to prevent stiffness 3, 1
• Hand stiffness is one of the most functionally disabling adverse effects of distal radius fractures 3
• Finger motion does not adversely affect adequately stabilized distal radius fractures 3

Duration of Immobilization

• Average immobilization duration is approximately 3-4 weeks 1
• After the immobilization period, progressive range of motion exercises should be started 1

Post-Surgical Considerations

Splinting After Surgical Fixation

• Evidence suggests that wearing a splint after volar locking plate fixation of a distal radius fracture is unnecessary 4
• Patients without splinting after volar locking plate fixation showed better outcomes in terms of wrist flexion, extension, pronation, supination, pain levels, and functional scores at 3 months 4

External Fixation Duration

• When external fixation is used, limiting the duration of fixation is recommended to reduce complications 3

Special Considerations

Adjunctive Treatments

• Ice application during the first 3-5 days can provide symptomatic relief 1
• Vitamin C is suggested for prevention of disproportionate pain 3
• Low-intensity pulsed ultrasonography (LIPUS) should NOT be used as it does not accelerate healing 1

Home Exercise Programs

• A directed home exercise program is an option for patients after the immobilization period 3, 1

Common Pitfalls and Caveats

• Excessive immobilization risks include chronic pain, joint stiffness, muscle atrophy, and complex regional pain syndrome 1
• Compartment syndrome is more common with circumferential casts 1
• Thermal injuries can occur during cast application 1
• Radiographic follow-up should be performed at 3 weeks and at cessation of immobilization 1

For unstable fractures requiring surgical intervention, the choice between percutaneous pinning with cast immobilization versus volar locking plate fixation should consider that volar plating shows better outcomes regarding post-surgical pain and wrist range of motion 5.