Initial Treatment of Distal Radius Fractures
The initial treatment depends on fracture displacement and stability: minimally displaced or nondisplaced fractures should be treated with closed reduction (if needed) and immobilization using either a sugar-tong splint followed by short-arm casting or a removable splint, while significantly displaced fractures (>3mm displacement or >10° dorsal tilt) or comminuted intraarticular fractures require surgical fixation with volar locked plating. 1, 2, 3
Assessment and Classification
Before initiating treatment, determine the fracture pattern through radiographic evaluation:
- Measure displacement and angulation: Significant displacement is defined as >3mm or dorsal tilt >10°, which indicates need for surgical intervention 1, 2
- Assess for intraarticular involvement: Comminuted intraarticular fractures typically require surgical management 2
- Obtain a post-reduction true lateral radiograph to assess distal radioulnar joint (DRUJ) alignment 4
- Consider CT scanning for improved diagnostic accuracy in complex intraarticular fractures 2
Treatment Algorithm by Fracture Type
Minimally Displaced or Nondisplaced Fractures
- Apply a sugar-tong splint initially, followed by transition to a short-arm cast for a minimum of 3 weeks 3
- Removable splints are an appropriate alternative for minimally displaced fractures, particularly buckle fractures 1
- Immobilization duration: Typically 3-4 weeks with radiographic follow-up at approximately 3 weeks and at time of immobilization removal 1
Significantly Displaced or Comminuted Intraarticular Fractures
- Volar locked plating is the primary treatment option, providing earlier functional return, better range of movement, less pain and disability, and earlier return of function compared to conservative management 2
- Arthroscopic-assisted reduction is an option for improved diagnostic accuracy and treatment of associated ligament injuries 2
- Bone grafting may be necessary for severely comminuted fractures with bone voids 2
Critical Early Interventions (All Fracture Types)
Immediate Finger Motion Protocol
- Instruct patients to perform active finger motion exercises immediately following diagnosis - this is one of the most cost-effective interventions to prevent finger stiffness, which is one of the most functionally disabling adverse effects 4, 1
- Finger motion does not adversely affect adequately stabilized fractures in terms of reduction or healing 1
- Hand stiffness can be very difficult to treat after fracture healing, requiring multiple therapy visits and possibly additional surgical intervention 4
Post-Immobilization Management
For surgically treated fractures:
- Immobilization periods of 1-3 weeks produce superior short-term outcomes compared to 6 weeks, with no significant differences in long-term function, range of motion, or pain at 3-6 months 5
- Early wrist motion is not routinely necessary following stable fracture fixation 4, 1
- A home exercise program is an option for patients prescribed therapy after distal radius fracture 4
Common Pitfalls and Monitoring
- Assess for median nerve injury, as distal radius fractures may be complicated by nerve involvement 3
- Monitor for unremitting pain during follow-up - these patients should be reevaluated for complications 4
- Watch for complications including skin irritation or muscle atrophy, which occur in approximately 14.7% of immobilization cases 1
- Avoid prolonged immobilization without finger motion, as this leads to functionally disabling stiffness that is difficult to reverse 4