J Korean Fract Soc.  2018 Apr;31(2):71-78. 10.12671/jkfs.2018.31.2.71.

Nonsurgical Treatment of a Distal Radius Fracture: When & How?

• Shin YH
• Yoon JO
• Kim JK

• KMID: 2409763
• DOI: http://doi.org/10.12671/jkfs.2018.31.2.71

Abstract

Distal radius fractures are a common upper extremity fracture and a considerable number of patients have a stable fracture. In the treatment of distal radius fractures, there is considerable disagreement regarding the need for a strict anatomical restoration with operation in elderly patients. Therefore, nonsurgical treatment is a still important treatment option in distal radius fractures. The radiological parameters of before or after manual reduction are important for deciding whether to perform operation or not. The radiological parameters include dorsal angulation of the articular surface, radial shortening, extent of dorsal comminution, intra-articular displacement, concomitant ulnar metaphyseal fracture, shear fracture, and fracture-dislocation of the distal radio-ulnar joint. In addition, clinical situations of patients, including age, activity level, underline disease, and recovery level, which the patients wish should be considered, comprehensively. For the duration of a splint or cast, three to four weeks are recommended in impacted or minimally displaced fractures and five to six weeks in displaced fractures. After reduction of the displaced fractures, patients should undergo a radiologicical examination every week to check the redisplacement or deformity of the fracture site until two or three weeks post trauma. Arm elevation is important for controlling fracture site swelling and finger exercises, including metacarpophalangeal joint motion, are needed to prevent hand stiffness. Active range of motion exercise of the wrist should be initiated immediately after removing the splint or cast.

Keyword

Distal radius fracture; Nonoperative treatment; Dorsal til; Radial shortening

MeSH Terms

Aged
Arm
Congenital Abnormalities
Exercise
Fingers
Hand
Humans
Joints
Metacarpophalangeal Joint
Radius Fractures*
Radius*
Range of Motion, Articular
Splints
Upper Extremity
Wrist

Figure

• 

  Fig. 1. Successful conservative treatment of a displaced distal radius fracture in a twenty year old woman. (A) Immediate post-trauma wrist anteroposterior and lateral X-ray. Dorsally displaced intra-articular distal radius fracture in the right wrist. (B) Wrist X-ray after manual reduction. Volar tilt of the distal radius and radial length were restored. (C) Wrist X-ray at post traumatic three months. The fracture site was well maintained and well united.

• 

  Fig. 2. Result of conservative treatment of an elderly patient with a displaced distal radius fracture. X-rays of a seventy one-year-old woman. (A) Wrist anteroposterior and lateral X-ray after the initial reduction. Distal radius and ulnar styloid fracture with intra-articular comminution in the left wrist. The volar tilt and radial length were well restored after the reduction. (B) Wrist X-ray shows radial shortening and dorsal tilt of distal radius at 1 year after trauma. (C) Range of motion of the left wrist was decreased slightly compared to the right side, but she performed her daily activities without pain at 1 year after trauma.

• 

  Fig. 3. Active finger range of motion exercise to prevent finger stiffness.

Reference

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