Is a wrist splint as effective as a wrist brace for managing a wrist fracture?

Wrist Splint vs. Brace for Fracture Management

For wrist fractures, rigid immobilization (casting) is preferred over removable splints for displaced fractures, while removable splints are appropriate for minimally displaced fractures. 1

Type of Fracture Determines Immobilization Method

• Rigid immobilization with casting is the preferred method for displaced distal radius fractures as recommended by the American Academy of Orthopaedic Surgeons 1
• Removable splints are appropriate options for minimally displaced distal radius fractures 1
• The immobilization device should secure the fracture while still allowing for finger motion to prevent stiffness 1
• Splinting in the position found is recommended unless straightening is necessary for safe transport 1, 2

Effectiveness Comparison

• For minimally displaced fractures, removable splints provide adequate stabilization while allowing for better functional outcomes 1, 3
• Functional braces are more effective than immobilization or compression wraps for ankle sprains, suggesting a similar principle may apply to wrist injuries where some controlled movement is beneficial 3
• Early mobilization after surgical management of distal radius fractures shows better functional outcomes at 6 weeks compared to splinting (Modified Mayo Wrist Score 65/100 vs. 55/100) 4
• Static progressive splinting has shown effectiveness in treating persistent wrist stiffness following distal radius fracture, with improvement in range of motion from a median of 65 degrees to 106 degrees at 12 weeks 5

Rehabilitation Considerations

• Active finger motion exercises should be performed following diagnosis to prevent stiffness, which is one of the most functionally disabling adverse effects of hand fractures 1, 2
• Finger motion does not adversely affect adequately stabilized distal radius fractures 2, 1
• Prolonged immobilization beyond what is necessary can lead to joint stiffness, muscle atrophy, and potentially more severe complications like complex regional pain syndrome 6

Follow-up Recommendations

• Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal 1
• Regular monitoring is essential to ensure proper recovery and to adjust treatment if needed 6
• For fractures with significant displacement (>3mm), dorsal tilt (>10°), or intra-articular involvement, surgical management may be indicated instead of conservative treatment 1

Potential Pitfalls and Complications

• Excessive immobilization can lead to chronic pain, joint stiffness, and muscle atrophy 6
• Inadequate stabilization of unstable injuries can result in malunion and subsequent joint dysfunction 7
• The psychological benefit and protective function of wrist splinting in patients who are at risk of falling should be considered 4

In summary, the choice between a wrist splint and brace should be guided by the type and severity of the fracture. For displaced fractures, rigid immobilization is preferred, while for minimally displaced fractures, removable splints provide adequate stabilization with better functional outcomes.