Treatment of Impacted Transverse Radial Metaphyseal Fracture
For an impacted transverse radial metaphyseal fracture, removable splinting is the recommended treatment option, particularly for minimally displaced fractures (displacement <3mm, dorsal tilt <10°, and without intra-articular involvement). 1
Assessment and Classification
- Fractures should be evaluated for displacement (significant if >3mm), angulation (significant if dorsal tilt >10°), and intra-articular involvement to determine the optimal treatment approach 1, 2
- Radiographic evaluation should be performed initially to confirm diagnosis and fracture pattern 2
Treatment Algorithm
For Minimally Displaced Fractures:
- Removable splint is the preferred treatment option as recommended by the American Academy of Orthopaedic Surgeons 1
- Duration of immobilization typically lasts 3-4 weeks 1, 2
- Radiographic follow-up should be performed at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 1
- Active finger motion exercises should be initiated following diagnosis to prevent stiffness, which is one of the most functionally disabling adverse effects of distal radius fractures 1
For Significantly Displaced Fractures:
- If displacement >3mm, dorsal tilt >10°, or intra-articular involvement is present, surgical management is indicated 1, 2
- Rigid immobilization (casting) is preferred over removable splints for displaced fractures that do not require surgical intervention 1
Rehabilitation Protocol
- Active finger motion exercises should be performed during the immobilization period to prevent stiffness 1
- Finger motion does not adversely affect adequately stabilized distal radius fractures in terms of reduction or healing 1
- Early wrist motion is not routinely necessary following stable fracture fixation 1
Potential Complications
- Immobilization-related adverse events occur in approximately 14.7% of cases and may include skin irritation and muscle atrophy 1, 2
- Joint stiffness is a potential complication without proper treatment and appropriate motion exercises 1, 2
Important Considerations
- The evidence strongly favors shorter immobilization periods (1-3 weeks) over longer periods (6 weeks) for better short-term outcomes in pain and function, though long-term outcomes are similar 3
- For pediatric patients with completely displaced metaphyseal fractures, percutaneous K-wire fixation has been shown to maintain alignment better than manipulation and casting alone 4
- Growth disturbances can occur following physeal injuries, particularly with certain fracture patterns, but most patients with radioulnar length discrepancies less than 1 cm remain asymptomatic long-term 5