Treatment of Non-Displaced Fractures
Non-displaced fractures should be treated with immobilization through casting or splinting, with the duration of immobilization dependent on fracture location, with 3 weeks being sufficient for many distal radius fractures. 1
Treatment Approach Based on Fracture Type
General Principles
- Non-displaced fractures generally have high union rates when treated promptly with appropriate immobilization 2
- The treatment approach should balance the need for fracture healing against the potential for complications from prolonged immobilization 1
- Early mobilization, when appropriate, leads to better functional outcomes in certain fracture types 1
Specific Fracture Types
Distal Radius Fractures
- Non-displaced or minimally displaced distal radius fractures can be effectively treated with cast immobilization 3
- Three weeks of cast immobilization has been shown to provide equal or better outcomes compared to five weeks for non-displaced distal radius fractures 1
- Patients with three weeks of immobilization demonstrated significantly better functional scores at one-year follow-up (PRWE 5.0 vs 8.8 points, QuickDASH 0.0 vs 12.5) 1
- Rigid immobilization is preferred over removable splints for displaced fractures 3
- Removable splints are an option for minimally displaced fractures 3
Proximal Humerus Fractures
- Most proximal humeral fractures can be treated non-operatively with good functional outcomes 3
- Treatment of displaced three-part and four-part fractures remains controversial and may require surgical intervention 3
Femoral Neck Fractures
- Stable non-displaced femoral neck fractures can be addressed with cannulated fixation in a percutaneous manner 3
- Displaced femoral neck fractures typically require surgical intervention with either hemiarthroplasty or total hip replacement 3
Lateral Humeral Condyle Fractures in Children
- Non-displaced or minimally displaced (<2mm) lateral humeral condyle fractures in children can be safely treated with cast immobilization 4
- Close follow-up with radiographs is necessary, particularly within the first week, to detect any subsequent displacement 5
- Union rates of 98% can be achieved with proper immobilization for 3-7 weeks 4
Monitoring During Treatment
- Radiographic follow-up is essential to detect potential displacement of initially non-displaced fractures 5
- For lateral humeral condyle fractures, radiographs between the fourth and sixth days are necessary to diagnose subsequent displacement of unstable fractures 5
- Regular assessment of pain levels and functional status should be performed throughout treatment 1
- Complications such as secondary displacement should be monitored, though the risk is low (reported as once per group in comparative studies) 1
Duration of Immobilization
- The optimal duration of immobilization varies by fracture type and location 1
- For distal radius fractures, 3 weeks of immobilization has shown better functional outcomes than 5 weeks 1
- For lateral humeral condyle fractures in children, 3-7 weeks of immobilization is typically required 4
- Shortening the period of immobilization when appropriate can lead to better functional outcomes without increasing complication rates 1
Potential Complications
- Subsequent displacement is a risk in initially non-displaced fractures, particularly within the first week 5
- Prolonged immobilization can lead to stiffness and reduced functional outcomes 1
- Non-union is rare in properly treated non-displaced fractures 4
- Secondary displacement requiring surgical intervention occurs in approximately 2% of non-displaced lateral humeral condyle fractures 4
Special Considerations
- For elderly patients with fragility fractures, appropriate treatment requires a balanced approach regarding operative versus non-operative management 3
- Patients with diabetes and active Charcot neuro-osteoarthropathy with non-displaced fractures require special consideration for offloading to prevent deformity progression 3
- Each patient aged 50 years and over with a recent fracture should be evaluated systematically for the risk of subsequent fractures 3
By following these evidence-based guidelines for the treatment of non-displaced fractures, optimal healing and functional outcomes can be achieved while minimizing complications and disability.