Short Arm Cast for Non-Displaced or Minimally Displaced Distal Radius Fractures
For non-displaced or minimally displaced distal radius fractures, a short arm cast is appropriate and sufficient—there is no need for a long arm cast. 1
Recommended Immobilization Approach
Type of Immobilization
- A removable splint is the preferred option for minimally displaced distal radius fractures, as recommended by the American Academy of Orthopaedic Surgeons. 1
- If rigid immobilization is chosen, a short arm cast provides adequate stabilization for these stable fractures. 1
- Long arm casts are not indicated for non-displaced or minimally displaced distal radius fractures, as the elbow does not require immobilization in these stable injury patterns.
Duration of Immobilization
- One week of cast immobilization is safe and effective for non- or minimally displaced distal radius fractures that do not require reduction. 2
- The most recent high-quality evidence from 2025 demonstrates that 1 week of immobilization followed by gradual mobilization produces equivalent functional outcomes, pain scores, and patient satisfaction compared to 3-5 weeks of immobilization, with no difference in secondary displacement rates (1.0% vs 1.5%, p=0.32). 2
- If a more conservative approach is preferred, 3 weeks of immobilization is also appropriate and shows better outcomes than longer periods. 3
- Avoid immobilization periods longer than 3 weeks, as they provide no additional benefit and result in worse short-term functional outcomes. 4
Immediate Post-Immobilization Management
Active Finger Motion
- Begin active finger motion exercises immediately after splint or cast application to prevent stiffness, which is one of the most functionally disabling complications of distal radius fractures. 1
- Finger motion does not adversely affect adequately stabilized distal radius fractures in terms of reduction or healing. 1
When Short Arm Casting is NOT Appropriate
Indications for Surgical Consideration
You must evaluate post-reduction radiographs for the following parameters that would indicate surgical fixation rather than casting: 1
- Radial shortening >3 mm
- Dorsal tilt >10°
- Intra-articular displacement
If any of these criteria are present, the fracture is considered unstable and surgical fixation should be recommended rather than conservative management. 5, 1
Follow-Up Protocol
- Obtain radiographs at approximately 3 weeks post-injury to confirm adequate healing. 1
- Repeat imaging at the time of immobilization removal is necessary. 1
- 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 5-6 weeks routinely—this outdated practice leads to worse short-term functional outcomes without any long-term benefit. 4, 2
- Do not restrict finger motion—this increases the risk of stiffness without providing any protective benefit to the fracture. 1
- Do not use a long arm cast—the elbow does not require immobilization in stable distal radius fractures, and this only increases patient burden without improving outcomes.