What is the recommended splint and treatment for a distal radius impacted fracture?

Distal Radius Impacted Fracture Splint and Treatment Recommendations

For distal radius impacted fractures, a sugar-tong splint is recommended for initial immobilization, followed by a short-arm cast for a minimum of three weeks for nondisplaced or minimally displaced fractures. 1

Initial Management

• Initial Immobilization Options:

  • Sugar-tong splint is the preferred initial immobilization method for nondisplaced or minimally displaced distal radius fractures 1
  • The splint should maintain the wrist in a neutral to slightly extended position to prevent complications
  • For impacted fractures specifically, immobilization should aim to prevent further displacement while allowing for proper healing

• Diagnostic Imaging:

  • Standard radiographs (posteroanterior, lateral, and oblique views) are essential for accurate diagnosis and assessment of fracture displacement 2
  • If radiographs are equivocal but clinical suspicion remains high, CT without contrast may be considered to confirm the fracture and assess fragment size 2

Treatment Algorithm

1. Assessment of Fracture Characteristics:

   • Evaluate for displacement (>3mm gap), angulation (>10 degrees), and articular involvement
   • Determine stability of the fracture

2. Conservative Management (for stable, nondisplaced or minimally displaced fractures):

   • Initial immobilization with sugar-tong splint 1
   • Conversion to short-arm cast after swelling subsides (typically 3-7 days)
   • Maintain immobilization for a minimum of three weeks 1
   • NSAIDs for pain and inflammation control 2

3. Surgical Management (for unstable or significantly displaced fractures):

   • Indicated for fractures with:
     • More than 50% joint involvement
     • Unstable joint
     • Displacement with interfragmentary gap >3mm
     • Significant angulation (>10 degrees)
     • Malrotation 2
   • Volar locking plate fixation is a common surgical approach for distal radius fractures

Post-Treatment Considerations

Post-Conservative Treatment

• Regular follow-up radiographs to ensure proper alignment is maintained
• Gradual mobilization after immobilization period
• Directed home exercise program to prevent stiffness 2

Post-Surgical Rehabilitation

• Recent evidence suggests early mobilization after stable surgical fixation may be beneficial:
  • A 2017 study demonstrated that early mobilization after volar locking plate fixation led to improved range of motion in the sagittal plane, better grip strength up to 6 months, and superior functional outcomes compared to 5 weeks of immobilization 3
  • A 2018 study found that patients without splinting after volar locking plate fixation had better flexion (85.5% vs 74.8%) and functional outcomes compared to those immobilized with a splint for 2 weeks 4
  • However, a 2024 randomized clinical trial found no significant differences between antebrachial splint and compression bandage immobilization for distal radius fractures treated with locking plates 5

Potential Complications and Pitfalls

• Watch for:

  • Median nerve injury, which can complicate distal radius fractures 1
  • Joint stiffness and chronic pain 2
  • Post-traumatic arthritis 2
  • Loss of reduction during immobilization period

• Prevention Strategies:

  • Limit duration of immobilization to reduce complications 2
  • Implement early range of motion exercises when appropriate 2
  • Monitor closely for signs of pressure points and skin breakdown, especially in diabetic patients 2

Special Considerations

• For elderly patients, evaluate for osteoporosis risk factors and consider calcium and vitamin D supplementation 2
• Advise smoking cessation as it increases nonunion rates and leads to inferior clinical outcomes 2
• Delayed treatment can lead to poor outcomes; persistent symptoms warrant prompt advanced imaging rather than prolonged observation 2

The evidence suggests that while sugar-tong splinting followed by casting remains the standard for conservative management of impacted distal radius fractures, the trend in post-surgical care is moving toward shorter immobilization periods or even immediate mobilization to improve functional outcomes.