What is the typical duration of non-weight bearing status for a patient with a distal radius (radius bone) fracture?

From the Guidelines

Patients with a distal radial fracture typically remain non-weight bearing through the affected wrist for approximately 6 weeks, though this can vary based on fracture severity and individual healing rates. Initially, the wrist is immobilized in a splint or cast to maintain proper alignment of the fracture fragments and protect the healing bone. During this period, patients should avoid putting weight through the hand and wrist, such as pushing up from a chair or bearing weight on the affected arm. After 6 weeks, if X-rays show adequate healing, gradual weight bearing may begin under the guidance of a healthcare provider, often with physical therapy to restore strength and range of motion. More complex fractures, especially those requiring surgical fixation with plates and screws, might require longer non-weight bearing periods of 8-12 weeks. The non-weight bearing period is crucial because premature weight bearing can displace the fracture fragments, leading to malunion, prolonged pain, and functional limitations. Elderly patients or those with osteoporosis may require longer healing times due to decreased bone density and healing capacity. According to the American Academy of Orthopaedic Surgeons (AAOS) and the American Society for Surgery of the Hand (ASSH) clinical practice guideline summary management of distal radius fractures 1, the management of distal radius fractures involves a multidisciplinary approach, and the treatment plan should be individualized based on the patient's age, fracture severity, and overall health status.

Some key points to consider in the management of distal radius fractures include:

• The use of arthroscopic assistance for evaluation of the articular surface during operative treatment of distal radius fractures is not supported by moderate evidence 1.
• The indication for fixation of distal radius fractures has been updated to reflect patients under the age of 65, with moderate support for operative fixation in non-geriatric patients with post-reduction radial shortening >3mm, dorsal tilt >10 degrees, or intra-articular displacement or step-off >2mm 1.
• The use of a home exercise program and supervised therapy following the treatment of distal radius fractures has been unchanged from the prior CPG iteration, with inconsistent evidence to support its use 1.
• New to the CPG this year is a statement regarding opioid use, with little high-quality evidence to inform guidelines, and the committee recommends consideration of multimodal and opioid-sparing protocols when possible 1.

It is essential to note that the evidence regarding the use of a supervised therapy program, serial radiography, and pain control remains limited, and these represent opportunity areas for future investigation 1. The updated strength of recommendations from the 2009 to 2020 CPG demonstrates that evidence, particularly in quality, continues to grow, which provides more definitive guidance for the treatment of distal radius fractures 1.

In terms of specific treatment recommendations, the AAOS and ASSH guideline summary provides moderate evidence to support the use of volar locked plates for operative fixation of distal radius fractures, with earlier recovery of function in the short term 1. However, the guideline also notes that there is no difference in outcomes between fixation techniques for complete articular or unstable distal radius fractures, aside from the observation that volar locked plating leads to earlier, short-term functional improvement 1.

Overall, the management of distal radius fractures requires a comprehensive approach, taking into account the patient's individual needs and fracture severity, and the treatment plan should be guided by the best available evidence and clinical expertise.

From the Research

Typical Duration of Non-Weight Bearing Status for Distal Radius Fractures

The typical duration of non-weight bearing status for a patient with a distal radius fracture can vary depending on the treatment approach and the specific characteristics of the fracture.

• Studies have investigated the optimal period of immobilization for non- or minimally displaced distal radial fractures, with some suggesting that shorter periods of immobilization may be beneficial 2, 3, 4.
• A randomized controlled trial found that 3 weeks of cast immobilization resulted in significantly better patient-reported outcomes compared to 5 weeks of immobilization 2.
• Another study protocol aimed to compare 1 week of brace immobilization with 3 weeks of cast immobilization in patients with non- or minimally displaced distal radius fractures 4.
• A randomized controlled trial comparing 1,3, and 6 weeks of postoperative immobilization after open reduction and internal fixation of distal radial fractures found that immobilization periods of 1 and 3 weeks produced superior short-term outcomes compared to 6 weeks of immobilization 5.
• A systematic review of rehabilitation interventions for distal radial fractures in adults found that the evidence was insufficient to establish the relative effectiveness of various interventions, and further research is needed 6.

Immobilization Periods

Some studies have investigated the effects of different immobilization periods on functional outcomes and pain after distal radius fractures.

• A study found that 3 weeks of immobilization resulted in better functional outcomes and less pain compared to 6 weeks of immobilization 5.
• Another study found that 1 week of immobilization may be safe and effective for non- or minimally displaced distal radius fractures 4.

Rehabilitation Interventions

Rehabilitation interventions, such as active and passive mobilization exercises, and training for activities of daily living, may be used to improve functional outcomes after distal radius fractures.

• A systematic review found that the evidence for the effectiveness of these interventions was limited and of low quality 6.
• Some studies have found beneficial effects of specific interventions, such as hand therapy, occupational therapy, and physiotherapy, but the evidence is generally limited by small sample sizes and methodological shortcomings 6.