Treatment of Distal Radius Fractures
The treatment of distal radius fractures should be based on fracture characteristics, with nondisplaced or minimally displaced fractures managed conservatively using immobilization, while displaced fractures with significant angulation, articular involvement, or instability require surgical intervention. 1
Initial Assessment and Diagnosis
- Obtain standard radiographs (posteroanterior, lateral, and oblique views) for initial diagnosis
- If radiographs are equivocal but clinical suspicion remains high, CT without contrast is recommended to confirm fracture and assess fragment size
- MRI without contrast can be useful to evaluate associated soft tissue injuries, particularly volar plate tears
Treatment Algorithm
Conservative Management
Conservative treatment is indicated for:
- Nondisplaced or minimally displaced fractures
- Fractures with less than 50% joint involvement
- Stable joint
- Minimal displacement (less than 10 degrees angulation)
The conservative approach includes:
- Initial immobilization with a sugar-tong splint
- Followed by a short-arm cast for a minimum of three weeks 1
- NSAIDs for pain and inflammation control
Surgical Management
Surgery should be considered for:
- Fractures involving more than 50% of the articular surface
- Unstable joints
- Displacement with interfragmentary gap >3 mm
- Significant angulation (>10 degrees)
- Malrotation
The most recent evidence suggests that open reduction and internal fixation (ORIF) using the dorsal compression reduction technique (DCRT) with a Weber clamp provides a safe and effective method for surgical management of distal radius fractures 2. This technique minimizes the risks of penetrating skin or fracturing bone during reduction due to its broad distribution of compression forces.
Special Considerations
For Children
- Buckle (torus) fractures and greenstick fractures are common
- Can often be managed with immobilization depending on the degree of angulation
For Adults
- Be vigilant for potential median nerve injury as a complication 1
- Consider removable splints as an alternative to casts for minimally displaced fractures that don't require manipulation 3
Management of Complications
Malunion
- For nascent malunion (poor alignment before complete healing): corrective intervention may prevent long-term functional problems
- For mature malunion (healed fracture with functional problems related to alignment): corrective osteotomy may be offered 4
Nonunion
- Associated with painful instability and poor hand function
- Operative treatment has proven successful even with small distal fragments 4
- Plates with angular stable screws (locking plates) have facilitated reconstruction
Post-traumatic Arthritis
- Wrist denervation may be considered for patients with good but painful wrist motion
- Complete arthrodesis for patients with less than functional range of motion 5
- Trial immobilization can help evaluate potential outcomes of arthrodesis
Rehabilitation and Follow-up
- Early mobilization after stable surgical fixation may be beneficial
- A directed home exercise program including active motion exercises helps prevent stiffness
- Limiting the duration of immobilization reduces complications
- Regular movement through complete range of motion is crucial for optimal outcomes
Pitfalls and Caveats
- Delayed treatment can lead to poor outcomes
- Persistent symptoms warrant prompt advanced imaging rather than prolonged observation
- Complications may include joint stiffness, chronic pain, recurrent instability, post-traumatic arthritis, and extensor lag
- Patients with diabetes require close monitoring of skin to prevent pressure points and breakdown
- Advise smoking cessation as it increases nonunion rates and leads to inferior clinical outcomes