Management of Displaced Distal Radius Fractures

Initial Assessment and Treatment

The American Academy of Orthopaedic Surgeons recommends rigid immobilization over removable splints for displaced distal radius fractures (moderate strength recommendation) 1
Displacement, comminution, and intra-articular extension are key fracture characteristics that mandate rigid immobilization 1
Comminuted fractures are inherently unstable and prone to loss of reduction 1
Intra-articular extension requires precise alignment maintenance 3, 4
Impaction provides some inherent stability, but does not eliminate the need for external support 1

Rigid cast immobilization is the standard of care for displaced fractures to maintain reduction 1, 2
Radiographic follow-up at 3 weeks is necessary to assess for secondary displacement, which is common in comminuted fractures 1, 2, 5
Additional radiographs at cessation of immobilization (typically 6 weeks total) are recommended 1
Active finger motion exercises should be started immediately to prevent stiffness 5

CT without IV contrast is the first-line study after radiographs to determine extent of comminution, displacement, and intra-articular extension 3, 4
Three-dimensional CT reconstructions are particularly helpful for preoperative planning in complex articular injuries 3, 4
Surgical fixation should be considered if adequate closed reduction cannot be achieved or maintained in a cast 1