From the Guidelines
For a non-displaced distal radius fracture in a 55-year-old female, a removable splint is a suitable option. The use of removable splints is supported by a study published in The Journal of the American Academy of Orthopaedic Surgeons in 2010 1, which suggests that removable splints can be used when treating minimally displaced distal radius fractures.
Key Considerations
- The splint should be well-padded and allow for finger movement to minimize stiffness.
- The patient should be instructed to monitor for signs of compartment syndrome, such as increasing pain, numbness, or tingling.
- Regular follow-up radiographs are necessary to ensure proper alignment is maintained during healing.
- The patient should perform regular finger, elbow, and shoulder exercises while in the splint to prevent stiffness in these joints.
Immobilization Period
The total immobilization period is typically around 6 weeks, with the initial management using a splint for 5-7 days to allow swelling to subside, followed by conversion to a short-arm cast if necessary.
Patient Education
The patient should be advised to keep the arm elevated above heart level for the first 48-72 hours to minimize swelling and to monitor for signs of compartment syndrome. Regular exercises should be performed to prevent stiffness in the fingers, elbow, and shoulder.
From the Research
Type of Splint for Displaced Distal Radius Fracture
- For a non- or minimally displaced distal radius fracture, a short-arm cast for a period of 3 weeks is recommended, as it leads to equal patient-reported outcomes with no negative side effects 2.
- However, for a displaced distal radius fracture, the type of splint or immobilization method may vary depending on the severity of the fracture and the treatment approach.
- A study on volar locking plate fixation of distal radius fractures found that wearing a splint after surgery is unnecessary, and immediate mobilization leads to better outcomes in terms of pain, Quick DASH, and PRWE scores 3.
- Another study on non-operative treatment of displaced distal radius fractures found that acceptable functional outcomes can be achieved, but at the expense of 40% subsequent surgeries due to secondary displacement or symptomatic malunion 4.
Immobilization and Rehabilitation
- Immobilization with or without reduction forms the mainstay of non-operative treatment for distal radius fractures 5.
- Patients should be encouraged to mobilize as soon as it is safe to do so, to prevent stiffness 5.
- A rehabilitation protocol started immediately after surgery, with pain management using transdermal buprenorphine or codeine/ibuprofen, can lead to faster functional recovery and better compliance to the rehabilitation program 6.
Considerations for Treatment
- The preferred management of distal radius fractures should consider the severity of the fracture, desired functional outcome, and patient comorbidities 5.
- Non-operative management can give good results, especially in older adults, while surgical management options include closed reduction and application of a cast, percutaneous K-wires, open reduction and internal fixation with plates, or external fixation 5.