What is the recommended treatment for a non-displaced distal radius metaphyseal fracture with mild angulation in a female patient?

Treatment of Non-Displaced Distal Radius Metaphyseal Fracture with Mild Angulation

Treat this fracture with a removable splint for 3 weeks, followed by radiographic confirmation of healing and gradual return to activity. 1

Initial Management

Conservative management with removable splinting is the appropriate treatment for this minimally displaced fracture. 1 The American Academy of Orthopaedic Surgeons specifically recommends removable splints as an appropriate option for minimally displaced distal radius fractures, which is superior to rigid casting for non-displaced injuries. 1

Key Treatment Parameters:

• Duration of immobilization: 3 weeks 1, 2
• Type of immobilization: Removable splint (not rigid cast) 1
• Immediate finger motion exercises should be started to prevent stiffness, which is one of the most functionally disabling complications 1

Critical Thresholds for Surgical Intervention

You must convert to surgical management if any of the following develop: 1, 3

• Radial shortening >3mm 1
• Dorsal tilt >10° 1
• Intra-articular displacement of any significance 1

These thresholds are absolute contraindications to continued conservative management and require surgical fixation. 1, 3

Mandatory Follow-Up Protocol

Obtain radiographs at two specific timepoints: 1

1. At 3 weeks post-injury - to detect any delayed displacement that would require surgical conversion 1, 3
2. At time of immobilization removal - to confirm adequate healing before discontinuing the splint 1

This follow-up is non-negotiable, as approximately 14.7% of patients develop complications during immobilization including skin irritation or muscle atrophy. 1, 3

Rehabilitation Protocol

Start active finger motion exercises immediately upon diagnosis. 1 Finger motion does not adversely affect adequately stabilized distal radius fractures in terms of reduction or healing. 1 However, early wrist motion is not routinely necessary following stable fracture fixation. 1

Adjunctive Treatments to Consider

• Vitamin C supplementation for prevention of disproportionate pain (moderate recommendation strength from AAOS) 1
• Ultrasound and/or ice as adjuvant treatments, though evidence is weak 1

Common Pitfalls to Avoid

Do not remove immobilization before 3 weeks - premature removal can lead to displacement or nonunion. 2 The evidence from older Cochrane reviews 4, 5 demonstrates that while surgical methods produce better anatomical appearance, they do not consistently produce better functional outcomes for minimally displaced fractures, supporting the conservative approach outlined above.

Do not use rigid casting - removable splints are specifically recommended over casts for this fracture pattern. 1 Recent evidence suggests that one week may be sufficient for truly non-displaced fractures 6, but the current guideline standard remains 3 weeks with mandatory radiographic follow-up. 1