What is the recommended urgent care management for a distal radial head fracture?

Urgent Care Management of Distal Radial Head Fracture

For distal radial fractures in the urgent care setting, removable splints are recommended as an appropriate initial treatment option for minimally displaced fractures, while significantly displaced or intra-articular fractures require orthopedic consultation for potential surgical management. 1

Initial Assessment and Classification

• Evaluate the degree of displacement, with significant displacement defined as >3mm displacement or >10° dorsal tilt 1, 2
• Assess for intra-articular involvement, which may necessitate more aggressive management 2
• Consider CT scanning to improve diagnostic accuracy for complex or intra-articular fractures 2
• Examine for associated injuries, including ligamentous injuries or concomitant fractures, which may affect management decisions 3

Treatment Algorithm Based on Fracture Type

Minimally Displaced Fractures (Buckle/Torus Fractures)

• Apply removable splint as the initial treatment of choice 1
• Schedule radiographic follow-up at approximately 3 weeks to confirm adequate healing 1
• Encourage active finger motion exercises to prevent stiffness, which is one of the most functionally disabling adverse effects 1
• Monitor for immobilization-related adverse events, which occur in approximately 14.7% of cases and may include skin irritation and muscle atrophy 1

Significantly Displaced or Intra-articular Fractures

• Arrange urgent orthopedic consultation for potential surgical management 2
• Volar locked plating is recommended by the American Academy of Orthopaedic Surgeons for comminuted intra-articular fractures 2
• Temporary sugar-tong splinting is appropriate while awaiting definitive treatment 4
• Be vigilant for potential median nerve injury, which can complicate distal radius fractures 4

Adjunctive Treatments

• Consider vitamin C supplementation for prevention of disproportionate pain, which has moderate recommendation strength from AAOS 3
• Ice application may provide benefit in the first 3-5 days post-injury 3
• Ultrasound is an option for adjuvant treatment, though evidence for long-term benefit is limited 3

Important Considerations and Pitfalls

• Avoid overlooking associated injuries, particularly when dealing with high-energy trauma 3
• Be aware that arthroscopic assistance for evaluation during operative treatment is no longer strongly supported by evidence 3
• For unstable fractures with associated ligamentous injuries, preservation of radial length is critical to prevent chronic wrist pain and stiffness 5
• Failure to identify and properly manage associated ulnar styloid fractures may lead to poorer outcomes, though evidence for routine fixation is inconclusive 3

Follow-up Recommendations

• Schedule radiographic follow-up at approximately 3 weeks and at the time of immobilization removal 1
• If initial imaging is negative but clinical suspicion remains high, consider splinting and repeat radiography in 7-14 days 4
• Minimum immobilization period for nondisplaced or minimally displaced fractures should be three weeks 4