From the Guidelines
For a distal radial fracture, a removable splint is a viable option, particularly for minimally displaced fractures, as suggested by the study published in The Journal of the American Academy of Orthopaedic Surgeons 1. When considering the type of splint for a distal radial fracture, several factors come into play, including the degree of displacement, the stability of the fracture, and the patient's overall condition.
- The use of removable splints, as mentioned in the study 1, offers the advantage of ease of use and adjustment, which can be particularly beneficial for patients with minimally displaced fractures.
- However, it's crucial to ensure that the chosen splint provides adequate support and stability to the fracture site, preventing unnecessary movement that could hinder the healing process.
- In clinical practice, the decision on the type of splint should be made on a case-by-case basis, taking into account the specific characteristics of the fracture and the patient's needs.
- While the study 1 provides a recommendation for the use of removable splints, it's classified as a weak recommendation, indicating that the evidence may not be as strong or consistent as desired.
- Despite this, in the context of real-life clinical medicine, where the goal is to minimize morbidity, mortality, and improve quality of life, the use of a removable splint for minimally displaced distal radial fractures appears to be a reasonable approach, considering the potential benefits in terms of patient comfort and ease of management.
From the Research
Splint Types for Distal Radial Fractures
- The choice of splint for distal radial fractures can vary, with options including volar-dorsal splints, sugar-tong splints, and Muenster splints 2, 3.
- A study comparing sugar-tong and volar-dorsal splints found no significant difference in loss of reduction rates between the two splint groups 2.
- Another study comparing Muenster and sugar tong splints found no difference in clinical outcomes, but both groups showed reduced radiographic parameters 3.
- Volar locking plate fixation (VLP) has also been compared to external fixation (EF) in the treatment of distal radial fractures, with VLP showing earlier recovery of function and superior results in terms of pain and wrist extension 4.
- A prospective randomized study compared long-arm versus short-arm splinting for controlling initial displacement of fractures of the distal radius, and found that both sugar tong splints and short-arm radial gutter splints had comparable performance in maintaining the initial reduction of distal radius fractures 5.
Radiographic and Clinical Outcomes
- Radiographic outcomes, such as radial inclination, radial length, volar tilt, and intra-articular displacement, have been evaluated in various studies 2, 3, 4.
- Clinical outcomes, such as patient satisfaction, grip strength, and range of motion, have also been assessed 6, 2, 4, 5.
- The use of volar plates for unstable distal radius fractures has been shown to provide stable internal fixation and allow early function, with a low complication rate 6.
Comparison of Splint Types
- Sugar-tong splints and volar-dorsal splints have been compared, with no significant difference in loss of reduction rates found 2.
- Muenster splints and sugar tong splints have also been compared, with no difference in clinical outcomes found 3.
- Short-arm radial gutter splints have been compared to sugar tong splints, with patients in the short-arm radial gutter splint group having significantly better Disabilities of the Arm, Shoulder, and Hand scores 5.