What is the initial management for a nondisplaced distal radius fracture?

Initial Management of Nondisplaced Distal Radius Fractures

For nondisplaced distal radius fractures in adults, immobilize with a removable splint or short-arm cast for 1-3 weeks, initiate immediate active finger motion exercises, and obtain radiographic follow-up at 3 weeks to confirm healing. 1, 2

Immobilization Strategy

Duration of Immobilization

• The most recent high-quality evidence demonstrates that 1 week of cast immobilization is safe and effective for nondisplaced distal radius fractures, showing no clinically significant differences in functional outcomes, pain scores, or secondary displacement rates compared to traditional 3-5 week protocols 2
• A 2025 stepped-wedge cluster randomized trial (n=402) found no difference in Patient Rated Wrist Evaluation (PRWE) scores, secondary dislocation rates (1.0% vs 1.5%), or operation rates between 1 week versus 3-5 weeks of immobilization 2
• If extending immobilization beyond 1 week, 3 weeks is superior to 5 weeks, with significantly better PRWE (5.0 vs 8.8 points, p=0.045) and QuickDASH scores (0.0 vs 12.5, p=0.026) at 1-year follow-up 3

Type of Immobilization

• Removable splints are recommended by the American Academy of Orthopaedic Surgeons as an appropriate option for minimally displaced distal radius fractures 1
• Short-arm cast is an acceptable alternative for nondisplaced fractures 3, 2

Active Motion Protocol

Immediate Finger Exercises

• Begin active finger motion exercises immediately following diagnosis to prevent stiffness, which is one of the most functionally disabling adverse effects of distal radius fractures 1
• Finger motion does not adversely affect adequately stabilized distal radius fractures in terms of reduction or healing 1

Wrist Motion

• Early wrist motion is not routinely necessary following stable fracture fixation 1
• After cast removal at 1 week, gradually increase wrist mobilization 2

Radiographic Follow-Up

• Obtain radiographic follow-up at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 1
• This timing allows detection of any secondary displacement, which occurs in approximately 1% of cases 2

Red Flags Requiring Surgical Consideration

Radiographic Parameters

• If post-reduction imaging shows radial shortening >3mm, dorsal tilt >10°, or intra-articular displacement, surgical fixation is suggested rather than conservative management 4, 1
• These parameters indicate instability and predict poor outcomes with casting alone 4

Clinical Indicators

• Persistent nerve dysfunction after reduction may require nerve decompression, though evidence is inconclusive 4
• Monitor for complications including skin irritation or muscle atrophy, which occur in approximately 14.7% of immobilization cases 1

Common Pitfalls to Avoid

• Do not immobilize for the traditional 4-6 weeks when fracture is truly nondisplaced—this leads to unnecessary stiffness and worse functional outcomes 3, 2
• Do not restrict finger motion during immobilization, as this increases risk of stiffness without improving fracture stability 1
• Ensure fracture meets nondisplaced criteria (dorsal angulation <10-15°, radial shortening <2-3mm, articular step-off <2mm) before choosing conservative management 4, 1

Adjunctive Treatments

• Vitamin C supplementation is suggested for prevention of disproportionate pain (moderate recommendation strength) 4
• Ultrasound and/or ice are options for adjuvant treatment, though evidence is weak 4