Splinting for Midshaft Radius Fractures
For midshaft radius fractures, a sugar-tong splint is the recommended initial immobilization method, as it provides adequate stabilization while accommodating swelling. 1, 2
Rationale for Sugar-Tong Splint Selection
Sugar-tong splints are particularly effective for midshaft forearm fractures because they:
- Provide circumferential support from above the elbow to the hand, preventing rotation of the forearm
- Accommodate initial swelling better than circumferential casts
- Maintain fracture reduction effectively, particularly in proximal and midshaft forearm fractures 3
- Allow for proper immobilization while awaiting definitive treatment
Application Technique
The sugar-tong splint for midshaft radius fractures should:
- Extend from the upper arm, around the elbow, and to the hand
- Maintain the wrist in a neutral to slight extension position
- Immobilize the elbow at approximately 90 degrees of flexion
- Leave the fingers free to allow for immediate finger motion exercises
Duration and Follow-up
- Initial immobilization with the sugar-tong splint should be maintained for approximately 1-2 weeks 1
- Follow-up radiography should be performed within 7-10 days to assess fracture stability 1
- After the initial period, conversion to a circumferential cast may be considered if swelling has subsided
Evidence Considerations
Research shows that sugar-tong splints are particularly effective for midshaft forearm fractures compared to other locations. One study demonstrated that sugar-tong splints performed best in proximal and mid-shaft forearm fractures, with lower rates of loss of reduction compared to distal fractures 3.
While some evidence suggests that short-arm radial gutter splints may be better tolerated by patients with distal radius fractures 4, this finding cannot be directly extrapolated to midshaft fractures, which require more extensive immobilization to prevent rotation.
Important Clinical Considerations
- Active finger motion exercises should begin immediately following diagnosis to prevent stiffness 5, 1
- Excessive immobilization risks include chronic pain, joint stiffness, muscle atrophy, and complex regional pain syndrome 1
- Consider vitamin C supplementation for prevention of disproportionate pain 5, 1
- For isolated midshaft ulna (nightstick) fractures, treatment depends on the degree of displacement and angulation 2
- Combined fractures involving both the ulna and radius generally require surgical correction 2
Pitfalls to Avoid
- Inadequate immobilization leading to fracture displacement
- Overly tight application causing neurovascular compromise
- Failure to leave fingers free for early range of motion exercises
- Neglecting to provide patient education on the importance of elevation and finger exercises
- Missing associated injuries (particularly in both-bone forearm fractures)
Remember that the choice between surgical and non-surgical management depends on the degree of displacement, angulation, and whether both bones are involved. Isolated, non-displaced or minimally displaced midshaft radius fractures are typically amenable to splinting, while significantly displaced fractures or those involving both bones often require surgical intervention.