Management of Healing Distal Radius Fracture with Equivocal Physeal Extension (Non-Widened)
For a healing distal radius fracture with equivocal extension to a non-widened physis, continue conservative management with immobilization and close radiographic monitoring, while immediately initiating active finger motion exercises to prevent stiffness. 1, 2
Initial Assessment and Monitoring Strategy
Serial radiographic evaluation is essential to detect any progression of physeal involvement or displacement. The American Academy of Orthopaedic Surgeons recommends obtaining radiographs at approximately 3 weeks and at cessation of immobilization to ensure maintained alignment 1, 2. For equivocal physeal involvement, more frequent imaging may be warranted initially to detect any widening or displacement early, though routine protocols show no difference in outcomes based on frequency alone 1.
Key Radiographic Parameters to Monitor:
- Displacement >3mm or dorsal tilt >10° indicates significant displacement requiring intervention 1, 2
- Physeal widening on serial films would indicate progression and potential growth arrest 3
- A post-reduction true lateral radiograph should assess DRUJ alignment 4, 2
Conservative Management Protocol
Continue rigid immobilization for the standard 3-6 week duration if the fracture remains stable and non-displaced 1, 2. Since the physis is not widened and the fracture is healing, surgical intervention is not indicated at this time 1.
Critical Early Intervention to Prevent Complications:
Immediately instruct the patient to perform active finger motion exercises throughout the entire immobilization period. 4, 1, 2 This is one of the most important interventions, as finger stiffness is one of the most functionally disabling adverse effects following distal radius fracture 4. Hand stiffness can be very difficult to treat after fracture healing, requiring multiple therapy visits and possibly additional surgical intervention 2.
- Finger motion does not adversely affect adequately stabilized distal radius fractures in terms of reduction or healing 1, 2
- This intervention is extremely cost-effective and provides significant impact on patient outcome 4
Follow-Up and Reassessment
All patients with unremitting pain during follow-up must be reevaluated for complications 4. This is particularly important given the equivocal physeal involvement, as pain could indicate progression of physeal injury.
When to Consider Surgical Intervention:
Surgery becomes indicated if:
- The fracture displaces during follow-up with >3mm displacement or >10° angulation 1, 2
- Physeal widening develops on serial radiographs, suggesting progressive physeal arrest 3
- Volar locked plating would be the treatment of choice if surgical intervention becomes necessary, providing earlier functional return and better outcomes 4, 1
Rehabilitation After Immobilization
A home exercise program is an appropriate option for patients prescribed therapy after distal radius fracture 4. The American Academy of Orthopaedic Surgeons found no clinically important differences between routine supervised therapy versus instructions for home exercises 5.
Early wrist motion is not routinely necessary following stable fracture fixation 1, 2, but progressive range of motion should begin after immobilization cessation.
Critical Pitfalls to Avoid
The most critical error is failing to initiate finger motion exercises immediately, as finger stiffness is the most functionally disabling complication and is difficult to reverse once established 4, 1, 2.
Avoid multiple attempts at reduction if displacement occurs, as this is a known risk factor for physeal arrest 3. If the fracture displaces significantly, proceed directly to surgical fixation rather than repeated closed reductions 3.
Do not dismiss equivocal physeal findings—timely recognition of physeal arrest allows for more predictable procedures such as distal ulnar epiphysiodesis before ulnar abutment develops 3.
Adjunctive Treatments to Consider
Vitamin C supplementation is suggested for prevention of disproportionate pain 1, and ultrasound and/or ice are options for adjuvant treatment 1.