What type of splint is recommended for an adult with a minimally displaced distal radius fracture that is stable after closed reduction?

Splint Type for Minimally Displaced Distal Radial Fractures

For minimally displaced distal radius fractures in adults, removable splints are an acceptable treatment option, though rigid immobilization (cast) remains preferred for displaced fractures requiring reduction. 1

Primary Recommendation

The American Academy of Orthopaedic Surgeons explicitly states that removable splints are an option when treating minimally displaced distal radius fractures (Recommendation 8, Weak strength). 1 This distinguishes minimally displaced fractures from displaced fractures requiring reduction, where rigid immobilization is preferred over removable splints (Recommendation 7, Moderate strength). 1

Splint Selection Algorithm

For Minimally Displaced Fractures (Your Clinical Scenario):

• Removable splint is acceptable for comfort and early mobilization 1
• The splint must be easily removable to allow active range-of-motion exercises several times daily 2
• A posterior splint or volar-dorsal splint can be used 3

For Displaced Fractures After Closed Reduction:

• Rigid cast immobilization is preferred over removable splints 1
• Volar-dorsal splinting showed 16% loss of reduction compared to 20% with circumferential casting (not statistically significant) 3
• Modified sugar-tong splinting showed higher loss of reduction at 30% and should be avoided 3

Duration of Immobilization

For minimally displaced fractures, 3 weeks of immobilization is sufficient and produces better functional outcomes than longer periods. 4

• Three weeks versus five weeks showed significantly better PRWE scores (5.0 vs 8.8 points, p=0.045) and QuickDASH scores (0.0 vs 12.5, p=0.026) at one year 4
• Secondary displacement occurred equally rarely in both groups (one case each) 4
• For displaced fractures after reduction, four weeks is equivalent to six weeks with no clinically relevant difference in outcomes 5

Critical Follow-Up Requirements

Obtain radiographic follow-up at 3 weeks to verify maintained alignment, regardless of splint type used. 1, 2

• Continue radiographic monitoring through cessation of immobilization 1
• This is essential because loss of reduction can occur in 16-30% of cases depending on immobilization method 3

Early Mobilization Protocol

Initiate active finger-motion exercises immediately to prevent stiffness, the most functionally disabling complication. 2

• Joint stiffness is one of the most disabling adverse effects and can be minimized with early appropriate motion 6
• The removable splint allows the patient to perform active ROM exercises multiple times daily 2
• Immobilization-related complications (skin irritation, muscle atrophy) occur in approximately 14.7% of cases 6, 2

Common Pitfalls to Avoid

Do not use modified sugar-tong splinting as it shows a clinically important trend toward increased loss of reduction (30% vs 16-20% for other methods). 3

Ensure the fracture meets criteria for "minimally displaced" before choosing a removable splint:

• Dorsal angulation <15° 7
• Volar tilt <20° 7
• Radial inclination >15° 7
• Ulnar positive variance <5mm 7
• Articular step-off <2mm 7

Do not apply excessive cast padding if using rigid immobilization, as a cast index ≥0.8 increases risk of treatment failure. 8

Position of Immobilization

• The wrist should be held in gentle flexion and slight ulnar deviation 8
• Avoid exaggerated cotton-loader position as this increases pressure on the carpal tunnel 8
• Whether to immobilize the elbow remains inconclusive with insufficient data to make a recommendation 1