From the Guidelines
The management of distal radius fractures should prioritize a patient-centered approach, considering individual values, preferences, and functional demand, with operative fixation recommended for non-geriatric patients (less than 65 years of age) with post-reduction radial shortening >3mm, dorsal tilt >10 degrees, or intra-articular displacement or step-off >2mm, while non-operative treatment is suitable for geriatric patients (65 years of age or older) 1.
Initial Management
The initial management of distal radius fractures involves immobilization, which can be achieved with a cast or splint for 4-6 weeks, depending on the severity of the fracture. Pain management is also crucial and can be achieved with NSAIDs like ibuprofen or naproxen for 1-2 weeks 1.
Rehabilitation
Rehabilitation is an essential aspect of managing distal radius fractures. However, the evidence is inconsistent regarding the benefit of supervised hand therapy 1. Some studies suggest that supervised therapy may be beneficial in non-operatively treated distal radius fractures, while others show no difference in outcomes between supervised and independent exercises 1.
Operative vs. Non-Operative Treatment
The decision to operate or not should be based on the patient's age, functional demand, and fracture characteristics. Operative fixation is recommended for non-geriatric patients (less than 65 years of age) with post-reduction radial shortening >3mm, dorsal tilt >10 degrees, or intra-articular displacement or step-off >2mm, as it provides moderate evidence for improved outcomes 1. In contrast, non-operative treatment is suitable for geriatric patients (65 years of age or older), as surgical fixation does not lead to improved long-term patient-reported outcomes 1.
Serial Radiographic Imaging
Serial radiographic imaging is not necessary for patients treated for distal radius fractures, as no difference exists in outcomes based on the frequency of radiographic evaluation 1. Imaging should be performed only when clinically indicated, such as in cases of new trauma, significant pain, or loss of range of motion.
Additional Considerations
Adequate calcium and vitamin D intake should be encouraged to support bone healing 1. The prognosis is generally good with appropriate management, though some patients may experience residual stiffness or mild pain with certain activities for several months after injury.
From the Research
Management of Distal Radius Fractures
- The management of distal radius fractures can be conservative or surgical, depending on the severity and stability of the fracture 2, 3.
- Conservative treatment is indicated for stable fractures or multimorbid patients in a poor general condition, and involves precise reduction and stable retention in a plaster splint 2, 3.
- The total duration of immobilization for conservative treatment is typically 4-5 weeks 4, 2, 3.
- Physiotherapy and ergotherapy can start after 2 weeks of treatment, and is extended to the wrist after removal of the circular cast 3.
Immobilization Techniques
- Immobilization in supination or no restriction of forearm range of motion can result in similar outcomes for patients with distal radius fractures stabilized with a volar plate 5.
- A systematic review found that shorter immobilization treatments often yield equal or better outcomes than longer immobilizations for conservatively treated distal radius fractures 4.
- The use of a sugar-tong splint or a volar splint can result in similar outcomes for patients with distal radius fractures 5.
Reduction and Retention
- Reduction of distal radius fractures can be achieved through closed reduction, and retention can be maintained using a plaster splint or circular cast 2, 3.
- The reduction is controlled by X-ray and documented, and the patient is monitored closely for any signs of secondary displacement 2, 3.
- The use of ligamentotaxis and constant traction can aid in the reduction and retention of distal radius fractures 2.
Complications and Outcomes
- The rate of complications can be higher in surgical treatment compared to conservative treatment for distal radius fractures 2.
- Patient-reported outcome measurements, grip strength, and range of motion can be similar or better after conservative treatment compared to surgical treatment 4, 2.
- Clinically visible deformities can be present in a significant proportion of patients treated conservatively, but patients can still be satisfied with the functional or cosmetic results 2.