From the Guidelines
For a mildly displaced distal radial fracture with dorsal displacement of the epiphysis of approximately 3 mm, closed reduction followed by cast immobilization is the recommended treatment. This approach is supported by the most recent and highest quality study, which emphasizes the importance of proper reduction and immobilization in achieving optimal outcomes 1. The procedure involves administering local anesthesia, then applying longitudinal traction while pushing the displaced fragment anteriorly to restore normal alignment.
Key Considerations
- After reduction, a well-molded short arm cast (below the elbow) with three-point molding should be applied for 4-6 weeks, maintaining the wrist in slight flexion and ulnar deviation to prevent redisplacement.
- Weekly radiographs for the first 2-3 weeks are essential to monitor for loss of reduction.
- Pain management typically includes acetaminophen (500-1000 mg every 6 hours) or ibuprofen (400-600 mg every 6-8 hours) for 5-7 days.
- Elevation of the extremity above heart level and active finger motion exercises should begin immediately after casting to reduce swelling and maintain joint mobility.
Rationale
The American Academy of Orthopaedic Surgeons (AAOS) and the American Society for Surgery of the Hand (ASSH) have developed an evidence-based clinical practice guideline for the treatment of distal radius fractures, which supports the use of closed reduction and cast immobilization for mildly displaced fractures 1, 2. This approach is effective because most mildly displaced fractures remain stable after proper reduction and casting, with the molded cast providing the necessary support while the bone heals. If reduction cannot be maintained or if displacement worsens during follow-up, surgical intervention with percutaneous pinning or open reduction may become necessary.
From the Research
Treatment Options for Mildly Displaced Distal Radial Fractures
- Closed reduction and immobilization is a common treatment approach for mildly displaced distal radial fractures, as seen in studies 3, 4, 5.
- The goal of closed reduction is to restore acceptable alignment and stability to the fracture, allowing for proper healing and minimizing the risk of complications 4.
- Immobilization with a cast is typically used to support the fracture and promote healing, with the duration of immobilization varying depending on the severity of the fracture and patient factors 5, 6.
Considerations for Dorsal Displacement of the Epiphysis
- In cases where the epiphysis is dorsally displaced, as in the case of a 3 mm displacement, closed reduction and immobilization may be attempted first, but repeated forceful manipulations should be avoided due to the risk of complications such as growth arrest, compartment syndrome, and avascular necrosis of the epiphysis 3.
- If closed reduction is unsuccessful, open reduction and internal fixation with Kirschner wires or other fixation methods may be necessary to achieve and maintain proper alignment of the fracture 3, 5.
Evidence for Treatment Outcomes
- Studies have shown that closed reduction and immobilization can be an effective treatment approach for mildly displaced distal radial fractures, with high success rates and low complication rates 5, 6.
- However, the optimal duration of immobilization is still a topic of debate, with some studies suggesting that shorter periods of immobilization (e.g. 3 weeks) may be sufficient for non- or minimally displaced fractures 6.
- Other studies have compared closed reduction and immobilization to surgical fixation with volar locking plates, finding no significant differences in patient-reported outcomes or functional results 7.