Treatment of Distal Radius Fractures in Older Adults

Initial Assessment and Treatment Selection

The American Academy of Orthopaedic Surgeons recommends that older adults with distal radius fractures should be treated with removable splinting for 3 weeks for non-displaced or minimally displaced fractures, while displaced fractures requiring surgical fixation should be immobilized for only 1-3 weeks post-operatively to optimize functional recovery 1
Radiographic criteria for surgical vs conservative management include radial shortening >3mm, dorsal tilt >10°, and intra-articular displacement, and if any of these criteria are present, surgical fixation is indicated rather than conservative management 1

The American Academy of Orthopaedic Surgeons suggests limiting post-operative immobilization to 1-3 weeks maximum following volar plate fixation, as early mobilization produces equal or better outcomes than prolonged immobilization 2, 3
Limit the duration of external fixation to minimize complications, and avoid prolonged fixation beyond 3 weeks when possible, as studies show poorer outcomes with extended external fixation 2, 3

Begin active finger motion exercises immediately following diagnosis or surgery to prevent finger stiffness, which is one of the most functionally disabling complications of distal radius fractures 1

Consider vitamin C supplementation for prevention of disproportionate pain, with a moderate recommendation strength, as it represents the strongest adjunctive recommendation from AAOS guidelines 1, 2, 3

Concomitant ulnar styloid fractures do not require routine fixation, as available evidence shows no difference in outcomes between fixation and non-fixation of associated ulnar styloid fractures 2, 3

Do not delay finger motion exercises, as finger stiffness is highly disabling and preventable 1
Do not use prolonged external fixation, as duration should be minimized to reduce complications 2, 3