What is the most appropriate splint for a patient with a non-displaced distal radial (radius) metaphyseal fracture?

From the Guidelines

A removable splint is the most appropriate for a non-displaced distal radial metaphyseal fracture, as it allows for immobilization while accommodating potential swelling. This recommendation is based on the most recent and highest quality study available, which suggests that removable splints are an option for treating minimally displaced distal radius fractures 1. The use of a removable splint provides excellent stabilization of the fracture site while allowing for some degree of movement, which can help prevent stiffness and promote healing.

Key Considerations

• The splint should be applied with the wrist in slight extension (about 15-20 degrees) and neutral ulnar deviation to maintain proper anatomical alignment.
• The splint should remain in place for approximately 4-6 weeks, with follow-up radiographs at 1-2 weeks to ensure the fracture remains non-displaced.
• During this period, the patient should be instructed to keep the arm elevated above heart level when possible to minimize swelling, apply ice for 15-20 minutes several times daily for the first 48-72 hours, and perform gentle finger exercises to prevent stiffness.

Evidence Summary

The American Academy of Orthopaedic Surgeons (AAOS) and the American Society for Surgery of the Hand (ASSH) have developed an evidence-based clinical practice guideline for the treatment of distal radius fractures, which includes recommendations for immobilization and rehabilitation 1. While the guideline does not specifically recommend a particular type of splint, it suggests that removable splints are an option for treating minimally displaced distal radius fractures. A study published in 2022 found that the use of arthroscopic assistance for evaluation of the articular surface during operative treatment of distal radius fractures is not supported by moderate evidence 1. However, this study does not directly address the use of removable splints for non-displaced distal radial metaphyseal fractures.

Clinical Decision-Making

In clinical practice, the choice of splint for a non-displaced distal radial metaphyseal fracture should be based on the individual patient's needs and circumstances. The removable splint is a good option because it allows for immobilization while accommodating potential swelling, and it can be easily removed for rehabilitation exercises. However, the decision to use a removable splint should be made on a case-by-case basis, taking into account the patient's overall health, activity level, and other factors that may affect the healing process.

From the Research

Splint Options for Non-Displaced Distal Radial Metaphyseal Fractures

• The most appropriate splint for a patient with a non-displaced distal radial metaphyseal fracture is not explicitly stated in the provided studies, as they primarily focus on displaced fractures or fractures in pediatric patients.
• However, a study on pediatric forearm fractures suggests that a sugar-tong splint can be an effective method for immobilization 2.
• Another study on distal forearm fractures in children recommends the use of a dorsal below elbow splint for 2-3 weeks for incomplete distal metaphyseal torus fractures 3.
• For adult patients with non- or minimally displaced distal radial fractures, a short-arm cast is commonly used, with a recommended immobilization period of 3 weeks 4.
• It is essential to note that the choice of splint may depend on the specific fracture characteristics, patient age, and other factors, and should be determined by a healthcare professional.

Key Considerations

• The primary goal of immobilization is to maintain fracture alignment and promote healing.
• The choice of splint should balance the need for immobilization with the potential risks and complications associated with each type of splint.
• Further research is needed to determine the most effective splint for non-displaced distal radial metaphyseal fractures in adult patients.

Relevant Studies

• 4: A randomized controlled trial on non- or minimally displaced distal radial fractures in adult patients, comparing 3 weeks versus 5 weeks of cast immobilization.
• 2: A retrospective study on pediatric forearm fractures, evaluating the effectiveness of sugar-tong splinting in maintaining reduction.
• 3: A case series on distal forearm fractures in children, describing current treatment practices and recommendations.
• 5: A study on the use of a distraction plate for distal radial fractures with metaphyseal and diaphyseal comminution.
• 6: A study on the re-displacement of extraphyseal distal radius fractures following initial reduction in skeletally immature patients, comparing sugar tongs splints to acute casting.