Initial Treatment of Distal Radius Fractures

Assessment and Classification

The American Academy of Orthopaedic Surgeons recommends measuring displacement and angulation to determine the need for surgical intervention, with significant displacement defined as >3mm or dorsal tilt >10° 1, 2
The assessment of intraarticular involvement is crucial, as comminuted intraarticular fractures typically require surgical management 2
A post-reduction true lateral radiograph should be obtained to assess distal radioulnar joint (DRUJ) alignment 3
Consider CT scanning for improved diagnostic accuracy in complex intraarticular fractures 2

For minimally displaced or nondisplaced fractures, removable splints are an appropriate alternative, particularly for buckle fractures 1
Immobilization duration is typically 3-4 weeks with radiographic follow-up at approximately 3 weeks and at time of immobilization removal 1
Volar locked plating is the primary treatment option for significantly displaced or comminuted intraarticular fractures, providing earlier functional return, better range of movement, less pain and disability, and earlier return of function compared to conservative management 2
Arthroscopic-assisted reduction is an option for improved diagnostic accuracy and treatment of associated ligament injuries 2
Bone grafting may be necessary for severely comminuted fractures with bone voids 2

Instruct patients to perform active finger motion exercises immediately following diagnosis to prevent finger stiffness, which is one of the most functionally disabling adverse effects 1, 3
Finger motion does not adversely affect adequately stabilized fractures in terms of reduction or healing 1
Hand stiffness can be very difficult to treat after fracture healing, requiring multiple therapy visits and possibly additional surgical intervention 3
Early wrist motion is not routinely necessary following stable fracture fixation 1, 3
A home exercise program is an option for patients prescribed therapy after distal radius fracture 3

Monitor for unremitting pain during follow-up, as these patients should be reevaluated for complications 3
Watch for complications including skin irritation or muscle atrophy, which occur in approximately 14.7% of immobilization cases 1
Avoid prolonged immobilization without finger motion, as this leads to functionally disabling stiffness that is difficult to reverse 3