What is the initial treatment for a distal non-displaced radial fracture?

Initial Treatment for Distal Non-Displaced Radial Fracture

The initial treatment for a distal non-displaced radial fracture should be immobilization with a splint or cast for 3-4 weeks, followed by radiographic reevaluation in 7-10 days to confirm the diagnosis and assess fracture stability. 1

Immediate Management

• Apply a sugar-tong splint initially to accommodate swelling 2
• Begin active finger motion exercises immediately to prevent stiffness 1
• Consider vitamin C supplementation for prevention of disproportionate pain 1
• Apply ice during the first 3-5 days for symptomatic relief 1
• NSAIDs are recommended for pain and inflammation control 1

Immobilization Period

• Convert to a short-arm cast after initial swelling subsides
• Recent evidence suggests that 3 weeks of immobilization may be sufficient and leads to better functional outcomes compared to traditional 5-week immobilization 3
• The American Academy of Orthopaedic Surgeons recommends an average immobilization duration of approximately 3-4 weeks 1
• Radiographic reevaluation should be performed in 7-10 days to confirm diagnosis and assess fracture stability 1

Monitoring for Complications

• Watch for signs of median nerve injury, which can complicate distal radius fractures 2
• Monitor for excessive displacement during follow-up (>3mm radial shortening, >10 degrees dorsal tilt, or intra-articular step-off >2mm), which may necessitate surgical intervention 1
• Be alert for signs of complex regional pain syndrome, which can result from excessive immobilization 1
• If a fractured extremity appears blue, purple, or pale, immediate emergency services should be activated 1

Rehabilitation

• After the immobilization period, begin progressive range of motion exercises 1
• A directed home exercise program is recommended 1
• Gradually return to activities as tolerated 1

Special Considerations

• For geriatric patients (≥65 years), non-operative treatment is strongly supported as surgical fixation does not improve long-term outcomes 1
• For younger patients with high functional demands, consider the patient's specific needs rather than strictly adhering to age cutoffs 1
• Advise patients who smoke about increased risk of nonunion and inferior clinical outcomes 1
• Evaluate elderly patients for osteoporosis risk, consider calcium and vitamin D supplementation, and assess fall risk factors 1

Follow-up Imaging

• If initial imaging findings are negative but clinical suspicion remains high, splint and repeat radiography in 7-14 days 2
• CT without IV contrast may be used for better visualization of fracture morphology in equivocal cases 1

The most recent evidence suggests that shortening the immobilization period to 3 weeks for non-displaced distal radial fractures leads to equal or better patient-reported outcomes compared to longer immobilization periods, with no increase in complications such as secondary displacement 3.