What are the treatments for arm fractures by location?

From the Guidelines

Treatments for arm fractures by location are varied and depend on the specific fracture and patient factors.

Treatments by Location

• Clavicle fractures: can be managed with or without surgery, but surgical treatment is increasingly being used for displaced fractures to reduce the risk of nonunion and symptomatic malunion 1.
• Distal radius fractures: treatment options include conservative management with immobilization and closed reduction, as well as surgical management with open reduction and internal fixation, with surgical fixation recommended for fractures with postreduction radial shortening >3 mm, dorsal tilt >10°, or intra-articular displacement 1.
• Supracondylar humerus fractures in children: nonsurgical immobilization is recommended for acute or nondisplaced fractures, while closed reduction with pin fixation is recommended for displaced type II and III and displaced flexion fractures 1.
• General considerations: the choice of treatment depends on the specific fracture pattern, patient age, and other factors, and should be individualized based on the patient's needs and preferences.

Key Considerations

• Surgical vs. nonsurgical treatment: the decision to use surgical or nonsurgical treatment depends on the specific fracture and patient factors, with surgical treatment often being used for more complex or displaced fractures.
• Fracture pattern and extent of injury: the fracture pattern and extent of injury can affect the choice of treatment, with more complex fractures often requiring surgical management.
• Patient age and activity level: patient age and activity level can also affect the choice of treatment, with younger, more active patients often requiring more aggressive treatment to restore function and mobility.

Evidence-Based Recommendations

• The American Academy of Orthopaedic Surgeons (AAOS) and the American Society for Surgery of the Hand (ASSH) have developed evidence-based clinical practice guidelines for the treatment of distal radius fractures, which recommend surgical fixation for fractures with postreduction radial shortening >3 mm, dorsal tilt >10°, or intra-articular displacement 1.
• The AAOS has also developed clinical practice guidelines for the treatment of clavicle fractures, which recommend surgical treatment for displaced fractures to reduce the risk of nonunion and symptomatic malunion 1.

From the Research

Treatments for Arm Fractures by Location

• Fractures of the radius and ulna are the most common fractures of the upper extremity, with distal fractures occurring more often than proximal fractures 2
• Treatment of forearm fractures depends on the location and severity of the fracture:
  • Distal radius fractures:
    • Nondisplaced or minimally displaced fractures are initially treated with a sugar-tong splint, followed by a short-arm cast for a minimum of three weeks 2
    • May be complicated by a median nerve injury 2
  • Midshaft ulna (nightstick) fractures:
    • Often caused by a direct blow to the forearm 2
    • Treated with immobilization or surgery, depending on the degree of displacement and angulation 2
  • Combined fractures involving both the ulna and radius:
    • Generally require surgical correction 2
  • Radial head fractures:
    • May be difficult to visualize on initial imaging 2
    • Treatment depends on the specific characteristics of the fracture using the Mason classification 2
    • Mason type I radial head fractures can be treated with a splint for five to seven days or with a sling as needed for comfort, along with early range-of-motion exercises 3
  • Olecranon fractures:
    • Patients are candidates for nonsurgical treatment if the elbow is stable and the extensor mechanism is intact 3
    • Traction band may be used for treatment 4
  • Open fractures:
    • Should have a higher therapeutic priority if they are associated with vessel/nerve lesions 4
    • External fixator may be the optimal approach in grade III open fractures of the upper extremity long bones 4
  • Comminuted or segmental diaphyseal fractures:
    • Require surgical management, including open reduction internal fixation with plates and screws 5
    • New directions in management include the use of intramedullary fixation and locking plate technology 5