What type of brace is recommended for a patient with a distal radius fracture?

Bracing Options for Distal Radius Fractures

For patients with distal radius fractures, a thermoplastic thumb spica splint is the recommended initial immobilization device, which should be worn for 4-6 weeks to maintain proper alignment and promote healing. 1

Initial Immobilization Options

• Thermoplastic thumb spica splint: Recommended as the primary immobilization device for distal radius fractures 1

  • Maintains proper alignment
  • Promotes healing
  • Should be worn for 4-6 weeks

• Compression bandage: May be an alternative to splinting for surgically treated fractures

  • Recent research shows no significant clinical or radiological differences between antebrachial splint and compression bandage for distal radius fractures treated with locking plates 2

Post-Surgical Immobilization Considerations

For surgically treated distal radius fractures with volar locking plates:

• Evidence suggests splinting may be unnecessary after volar locking plate fixation 3

  • Patients allowed immediate mobilization showed better outcomes in terms of:
    • Wrist flexion (85.5% vs 74.8%)
    • Pain scores (1.28/10 vs 1.72/10)
    • Quick DASH scores (19.57/100 vs 21.78/100) 3

• Early mobilization vs. splinting after surgical management:

  • Early mobilization showed better wrist function at 6-week follow-up without increased risk of secondary displacement 4
  • Consider the psychological benefit and protective function of splinting in patients at risk of falling 4

Important Clinical Considerations

• Finger motion: Encourage early finger motion regardless of immobilization type

  • Does not adversely affect adequately stabilized distal radius fractures
  • Helps minimize risk of finger stiffness, a critical adverse effect 5
  • Cost-effective intervention with significant impact on patient outcomes

• Duration of immobilization: When external fixation is used, limiting duration is recommended to reduce complications 5

• Adjuvant treatments:

  • Vitamin C supplementation is suggested for prevention of disproportionate pain 5
  • Ultrasound and/or ice are options for adjuvant treatment 5

Immobilization Protocol

1. Initial assessment: Determine if fracture requires surgical intervention
2. For non-surgical cases: Apply thermoplastic thumb spica splint for 4-6 weeks 1
3. For surgical cases with volar locking plate:
   • Consider early mobilization without splinting 3, 4
   • If splinting is used, limit to 2 weeks post-surgery 3
4. Regardless of immobilization type:
   • Instruct patient to move fingers regularly through complete range of motion 5
   • Apply cold therapy for 20-30 minutes, 3-4 times daily for pain and swelling 1
   • Consider vitamin C supplementation to prevent disproportionate pain 5

Pitfalls to Avoid

• Neglecting finger motion: Failure to encourage early finger movement can lead to stiffness and poor functional outcomes 5
• Prolonged immobilization: Extended external fixation is associated with poorer outcomes 5
• Overdistraction: When using external fixation, avoid excessive distraction of the wrist 5
• Rigid immobilization: Can lead to joint stiffness, particularly in children 1

Early finger motion and appropriate immobilization are crucial for optimal outcomes in distal radius fracture management, with emerging evidence suggesting benefits of early mobilization after stable surgical fixation.