Treatment for Non-Displaced Distal Radius Fracture in a 55-Year-Old
A 55-year-old patient with a truly non-displaced distal radius fracture should be treated non-operatively with immobilization in a well-molded cast for 5 weeks, followed by early mobilization and a home exercise program. 1
Rationale for Non-Operative Management
Your patient falls into the non-geriatric category (under 65 years), but the key distinction is that operative indications apply only to fractures that meet specific radiographic thresholds after reduction. 1 The AAOS/ASSH guidelines specify that surgery is indicated for non-geriatric patients when post-reduction imaging shows:
Since your fracture is non-displaced, none of these operative criteria are met, making non-operative treatment the appropriate choice regardless of the patient's age being under 65. 1
Immobilization Protocol
- Apply a rigid, well-molded plaster cast (not a removable splint) for displaced fractures requiring reduction; for truly non-displaced fractures, either cast or splint is acceptable, though cast provides more reliable immobilization 3
- Duration: 5 weeks of immobilization 4
- Obtain radiographs at 1-2 weeks post-injury to detect any early loss of reduction, as this is the critical window for identifying re-displacement 3
Post-Immobilization Rehabilitation
- Home exercise program is equivalent to supervised therapy for most patients with distal radius fractures 1
- Active range-of-motion exercises can be self-directed when proper instruction is provided 2
- Reserve supervised hand therapy only for patients who demonstrate limited functional recovery at follow-up 2
Pain Management
- Implement multimodal, opioid-sparing protocols using acetaminophen and NSAIDs (when not contraindicated) 2
- Limit opioid prescriptions to the minimum necessary 2
Critical Monitoring Points
Watch for early loss of reduction at the 1-2 week radiographic follow-up. 3 If the fracture displaces and now meets operative criteria (dorsal tilt >10°, shortening >3mm, or articular step-off >2mm), surgical intervention would then be indicated for this 55-year-old patient. 1
Evidence Supporting Conservative Management
Even when fractures do displace in patients ≥65 years, non-operative treatment yields similar functional outcomes and complication rates compared to surgery. 4 A 2023 prospective study found no significant differences in QuickDASH scores, pain, ROM, or grip strength at 1 year between displaced and non-displaced fractures treated conservatively in elderly patients. 4 While your 55-year-old patient is younger and would benefit from surgery if displacement occurs, a truly non-displaced fracture does not warrant the higher complication rates associated with operative intervention (37% vs 17% in one matched cohort study). 5