Management of Impacted Fractures of the Distal Radius

Initial Assessment

The American Academy of Orthopaedic Surgeons recommends determining fracture characteristics to guide treatment, including assessing the degree of displacement, with fractures having >3mm displacement or >10° dorsal tilt considered significantly displaced 2, 1
Evaluating articular involvement and joint congruity using plain radiographs is recommended 1
Consideration of CT scanning to improve diagnostic accuracy for intraarticular impacted fractures is suggested 1
Confirmation of intact neurovascular status is necessary 3

For minimally displaced/nondisplaced impacted fractures, removable splints are appropriate, while rigid immobilization is preferred if stability is a concern 2
Immobilization duration typically ranges from 3-6 weeks with radiographic follow-up at approximately 3 weeks and at cessation of immobilization 2, 1
Volar locked plating is the treatment of choice for comminuted intraarticular impacted fractures, providing earlier wrist mobilization, better range of movement, less pain and disability, and early return of function 1
The American Academy of Orthopaedic Surgeons suggests that volar locked plating leads to earlier recovery of function in the short term compared to other fixation methods 4
No difference exists in long-term outcomes between various fixation techniques for complete articular or unstable distal radius fractures, but volar locked plating offers superior early functional recovery 4

Vitamin C supplementation is suggested for prevention of disproportionate pain, with moderate strength recommendation 5
Ultrasound and/or ice are options for adjuvant treatment 5
The American Academy of Orthopaedic Surgeons recommends against routine fixation of associated ulnar styloid fractures due to insufficient evidence 5

Active finger motion exercises should be performed immediately following diagnosis or surgery to prevent stiffness, which is one of the most functionally disabling adverse effects 2, 1
Finger motion does not adversely affect adequately stabilized distal radius fractures 2
Early wrist motion is not routinely necessary following stable fracture fixation 2, 1

The American Academy of Orthopaedic Surgeons suggests that the frequency of imaging can be reduced without compromising outcomes, with no difference in outcomes based on frequency of radiographic evaluation 4
Routine radiographs at 1, 2, 6, and 12 weeks show no benefit over reduced imaging protocols 4

Overdistraction when using external fixation should be avoided, as prolonged external fixation is associated with poorer outcomes 5
Conservative management for comminuted intraarticular fractures should not be relied upon due to the risk of joint incongruity and subsequent arthritis 1
Loss of reduction should be monitored, and prevention of joint stiffness through early finger mobilization is crucial, as it is the most functionally disabling complication 2, 1