What is the treatment for a transverse radial metaphyseal fracture?

Treatment of Transverse Radial Metaphyseal Fracture

For transverse radial metaphyseal fractures, rigid immobilization is recommended for displaced fractures, while removable splints may be used for minimally displaced fractures. 1

Initial Assessment and Classification

• Careful evaluation of displacement, joint congruity, and stability is essential to determine optimal treatment approach 2
• Fractures are classified as significantly displaced when there is >3mm displacement or >10° dorsal tilt 2
• Radiographic evaluation, including true lateral views, is necessary to assess alignment and potential DRUJ involvement 1

Treatment Options Based on Displacement

For Minimally Displaced Fractures:

• Removable splints are an appropriate option for minimally displaced fractures 1
• Active finger motion exercises should be initiated immediately following diagnosis to prevent stiffness 1
• Follow-up radiographs should be obtained at approximately 3 weeks and at immobilization removal to confirm adequate healing 2

For Displaced Fractures:

• Rigid immobilization is preferred over removable splints for displaced fractures 1
• In children with completely displaced metaphyseal fractures, percutaneous Kirschner wire fixation in addition to casting significantly improves maintenance of reduction compared to casting alone 3
• Surgical fixation options include:
  • Percutaneous pinning for most fractures 3
  • Open reduction and internal fixation for fractures with significant displacement or joint involvement 4

Post-Treatment Management

• A home exercise program is an effective option for patients prescribed therapy after fracture treatment 1
• Active finger motion exercises should be performed following diagnosis to prevent stiffness, which is one of the most functionally disabling adverse effects 1
• All patients with unremitting pain during follow-up should be reevaluated to identify potential complications 1

Potential Complications

• Hand stiffness can result from pain, swelling, splint/cast obstruction, or patient apprehension 1
• Finger stiffness can be difficult to treat after fracture healing, potentially requiring multiple therapy visits and additional surgical intervention 1
• Loss of alignment is a common complication, particularly in displaced fractures treated without adequate fixation 1
• DRUJ instability may occur with distal radius fractures and should be assessed with a true lateral radiograph 1

Special Considerations

• In children, completely displaced metaphyseal fractures of the distal radius treated with manipulation and casting alone have a higher rate of requiring secondary procedures (21%) compared to those treated with additional K-wire fixation (0%) 3
• Open fractures require immediate surgical debridement and internal stabilization following the same principles as in adult patients 5