What is the treatment for a comminuted and minimally displaced mid diaphyseal fracture of the radius?

Treatment of Comminuted and Minimally Displaced Mid Diaphyseal Fracture of the Radius

For a comminuted and minimally displaced mid diaphyseal fracture of the radius, open reduction and internal fixation (ORIF) with plate fixation is the recommended treatment to ensure proper alignment and functional recovery. 1

Assessment and Classification

• Mid diaphyseal radius fractures should be carefully evaluated for displacement, comminution, and potential involvement of the ulna, as combined fractures require different management approaches 2
• Fractures are classified as significantly displaced when there is >3mm displacement or >10° angulation, which influences treatment decisions 3
• Radiographic evaluation is essential to confirm diagnosis and fracture pattern 2

Treatment Algorithm

Conservative Management

• Conservative management with immobilization is generally NOT recommended for mid diaphyseal radius fractures, even when minimally displaced, due to the high risk of displacement during healing 1
• Unlike distal radius buckle fractures, which can be managed with removable splints as per American Academy of Orthopaedic Surgeons recommendations, mid diaphyseal fractures have different biomechanical considerations 4

Surgical Management

• Open reduction and internal fixation with 3.5-mm compression plates using AO technique is the standard of care for displaced diaphyseal fractures of the radius 1
• Even minimally displaced comminuted fractures of the radius diaphysis should undergo surgical fixation to prevent later displacement and malunion 1
• Plate fixation provides sufficient stability with minimal loss of reduction for unstable fractures 5

Post-Operative Management

• Active finger motion exercises should be initiated as soon as stability allows to prevent stiffness, which is one of the most functionally disabling adverse effects of forearm fractures 4
• Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 4
• Typical healing time for diaphyseal fractures is 9-12 weeks, with clinicoradiological consolidation observed at a mean of 9.6 weeks in surgically treated forearm fractures 6

Potential Complications

• Complications of surgical treatment may include tendon irritation, hardware loosening, delayed union, and complex regional pain syndrome 5
• The overall complication rate for plate fixation of forearm fractures is approximately 27%, with tendon irritation being the most common issue 5
• Immobilization-related complications occur in approximately 14.7% of cases and may include skin irritation and muscle atrophy 4

Important Considerations

• Careful attention to surgical technique is crucial to minimize complications 1
• Assessment for concomitant ligamentous injury at the wrist or elbow is essential before proceeding with treatment 1
• Most patients can expect to return to previous employment within 4 months of injury (average 8.5 weeks) following appropriate surgical management 7
• Functional outcomes are generally good to excellent following surgical fixation, with most patients achieving functional range of motion and grip strength averaging 70-81% of the uninjured side 6, 5

Pitfalls to Avoid

• Do not confuse treatment protocols for distal radius fractures with those for mid diaphyseal fractures, as they require different management approaches 2
• Avoid conservative management for comminuted mid diaphyseal radius fractures, even if minimally displaced, as this can lead to malunion and functional impairment 1
• Be vigilant about plate positioning to prevent interference with the tendon systems 5