What is the recommended splint for a distal radius fracture?

Recommended Splint for Distal Radius Fracture

For initial immobilization of distal radius fractures, a sugar-tong splint is recommended as the standard approach for nondisplaced or minimally displaced fractures prior to conversion to a short-arm cast. 1, 2

Initial Immobilization Options

Sugar-Tong Splint

• Primary recommendation for initial immobilization of distal radius fractures
• Provides adequate stabilization while allowing for swelling
• Extends from the dorsal metacarpophalangeal joints, around the elbow, and to the palmar metacarpophalangeal joints
• Maintains reduction while accommodating post-injury edema

Volar-Dorsal Splint

• Alternative option with similar outcomes to sugar-tong splint
• Research shows no significant difference in loss of reduction rates between sugar-tong and volar-dorsal splints (28.8% vs 25.0%) 3
• May be slightly better at maintaining radial inclination compared to sugar-tong splints (19° vs 17.1°) 3

Management Algorithm

1. Initial Assessment:

   • Confirm diagnosis with standard radiographic views (posteroanterior, lateral, and oblique) 1
   • Assess fracture stability, displacement, and angulation

2. For nondisplaced or minimally displaced fractures:

   • Apply sugar-tong splint initially
   • Convert to short-arm cast after swelling subsides (typically 1-2 weeks)
   • Maintain immobilization for a minimum of three weeks 2

3. For displaced fractures requiring reduction:

   • Perform closed reduction
   • Apply sugar-tong splint at 30° of wrist extension
   • Schedule follow-up within 1 week to assess maintenance of reduction
   • Convert to short-arm cast if reduction is maintained

4. For unstable fractures or those with >50% joint involvement:

   • Consider surgical intervention with open reduction and internal fixation (ORIF) 1
   • Post-surgical immobilization may not be necessary with volar locking plate fixation 4

Evidence-Based Considerations

• Conservative management with immobilization is indicated for fractures with less than 50% joint involvement, stable joint, and minimal displacement (less than 10 degrees angulation) 1

• Recent evidence suggests that immobilization after volar locking plate fixation may be unnecessary. A study comparing patients with and without post-operative splinting showed better outcomes in the non-immobilized group at 3 months (flexion: 85.5% vs 74.8%) 4

• Early finger motion is essential regardless of immobilization method to prevent edema and stiffness 1

Common Pitfalls and Caveats

• Beware of median nerve injury which can complicate distal radius fractures 2
• Monitor for loss of reduction during follow-up visits with repeat radiographs
• Don't neglect early finger motion even when the wrist is immobilized
• Avoid prolonged immobilization as it can lead to significant muscle strength loss and bone resorption 1
• Consider patient age when making treatment decisions, as patients over 60 years may have different functional outcomes despite similar radiographic results 5

Follow-up Protocol

• Schedule radiographic follow-up within 7-14 days of initial splinting
• If initial imaging is negative but clinical suspicion remains high, apply splinting and repeat radiography in 7-14 days 2
• Assess for maintenance of reduction and conversion to definitive treatment (cast or surgery)
• Ensure appropriate monitoring through scheduled follow-up imaging 1