Can an impacted intra-articular distal radial fracture be treated with splinting alone?

No, Splinting Alone is Inadequate for Impacted Intra-articular Distal Radial Fractures

An impacted intra-articular distal radial fracture requires surgical management with volar locked plating, not splinting alone. 1

Why Splinting is Inappropriate

• Intra-articular fractures with any displacement require restoration of joint congruity to prevent post-traumatic arthritis and functional disability. 1 Conservative management with splinting carries significant risk of joint incongruity and subsequent arthritis. 1

• The American Academy of Orthopaedic Surgeons specifically recommends volar locked plating as the primary treatment for comminuted intra-articular fractures, providing earlier functional return and better functional outcomes compared to conservative management. 1

• Even with "impaction," these fractures typically have enough displacement or articular step-off to warrant surgical intervention—any displacement >3mm or dorsal tilt >10° is considered significantly displaced and requires surgery rather than splinting. 2, 1

When Splinting IS Appropriate (Not Your Case)

Splinting is only recommended for:

• Minimally displaced, non-intra-articular fractures (buckle fractures without cortical disruption or joint involvement) 2, 3
• Fractures with <3mm displacement, <10° dorsal tilt, and NO intra-articular involvement 2

Recommended Treatment Algorithm

For your impacted intra-articular fracture:

1. Obtain CT scanning to accurately assess the degree of articular displacement and comminution 1

2. Proceed with volar locked plating as the primary surgical treatment, which provides:

   • Earlier wrist mobilization 1
   • Better range of movement 1
   • Less pain and disability 1
   • Early return of function 1

3. Consider arthroscopic-assisted reduction for improved diagnostic accuracy and treatment of associated ligament injuries 1, 4

4. Bone grafting may be necessary for severely comminuted fractures with bone voids 1

Postoperative Management

• Begin active finger motion exercises immediately following surgery to prevent stiffness, which is one of the most functionally disabling complications 1

• Radiographic follow-up at approximately 3 weeks and at immobilization removal 1

• Early wrist motion is not routinely necessary following stable fracture fixation 1

Critical Pitfall to Avoid

Do not be misled by the term "impacted"—this does not mean the fracture is stable enough for conservative treatment. Intra-articular involvement fundamentally changes the treatment paradigm from splinting to surgical restoration of joint congruity. 1 Attempting conservative management risks permanent joint dysfunction and arthritis.