A DonJoy Brace is NOT Sufficient for This Fracture
A mildly displaced, impacted, comminuted distal radius fracture with possible intra-articular extension and ulnar styloid fracture requires rigid cast immobilization at minimum, not a removable orthotic brace like a DonJoy. 1, 2
Why Rigid Immobilization is Required
The American Academy of Orthopaedic Surgeons specifically recommends rigid immobilization over removable splints for displaced distal radius fractures (moderate strength recommendation). 1 The key fracture characteristics in your case that mandate rigid immobilization include:
- Displacement: Even mild displacement requires stable immobilization to prevent further displacement during healing 1
- Comminution: Multiple fracture fragments are inherently unstable and prone to loss of reduction 1
- Intra-articular extension: Joint surface involvement requires precise alignment maintenance 1
- Impaction: While impaction provides some inherent stability, it does not eliminate the need for external support 1
Appropriate Initial Management
Apply a short arm cast (not a removable brace) with the following protocol:
- Rigid cast immobilization is the standard of care for displaced fractures to maintain reduction 1, 2
- Radiographic follow-up at 3 weeks to assess for secondary displacement, which is common in comminuted fractures 1, 2, 3
- Additional radiographs at cessation of immobilization (typically 6 weeks total) 1
- Begin active finger motion exercises immediately to prevent stiffness, which is one of the most functionally disabling complications 3
The Ulnar Styloid Fracture Component
The associated ulnar styloid fracture typically does not require separate fixation when the radius is properly managed. 2, 4, 5 However, important considerations include:
- Guidelines are inconclusive regarding fixation of ulnar styloid fractures associated with distal radius fractures 2
- Recent research (2023) shows no significant difference in pain, functional outcomes, or DRUJ stability between surgically and conservatively treated ulnar styloid fractures when the radius is adequately stabilized 6, 7
- Base fractures with significant displacement (>2mm) have higher nonunion rates and may warrant consideration for fixation if DRUJ instability is present 6, 8
- In the absence of DRUJ instability, ulnar styloid fractures do not affect patient-rated outcomes after proper distal radius treatment 5
When to Consider Surgical Intervention
Further imaging with CT may be necessary given the complexity of your fracture:
- CT without IV contrast is the first-line study after radiographs to determine extent of comminution, displacement, and intra-articular extension 1
- Three-dimensional CT reconstructions are particularly helpful for preoperative planning in complex articular injuries 1
- Surgical fixation should be considered if adequate closed reduction cannot be achieved or maintained in a cast 1
Critical Pitfall to Avoid
Do not use a removable brace (like a DonJoy) for this fracture pattern. The American Academy of Orthopaedic Surgeons reserves removable splints only for minimally displaced distal radius fractures (weak recommendation), and your fracture does not meet this criterion due to displacement, comminution, and intra-articular involvement. 1 Using inadequate immobilization risks loss of reduction, malunion, and poor functional outcomes. 1, 2