Treatment of Distal Radius Fractures

Publication Date: December 5, 2009
Last Updated: March 14, 2022

Recommendations

1. We are unable to recommend for or against performing nerve decompression when nerve dysfunction persists after reduction. (Inconclusive)
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2. We are unable to recommend for or against casting as definitive treatment for unstable fractures that are initially adequately reduced. (Inconclusive)
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3. We suggest operative fixation for fractures with post-reduction radial shortening >3mm, dorsal tilt >10 degrees, or intra-articular displacement or step-off >2mm as opposed to cast fixation. (Moderate)
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4. We are unable to recommend for or against any one specific operative method for fixation of distal radius fractures. (Inconclusive)
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5. We are unable to recommend for or against operative treatment for patients over age 55 with distal radius fractures. (Inconclusive)
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6. We are unable to recommend for or against locking plates in patients over the age of 55 who are treated operatively. (Inconclusive)
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7. We suggest rigid immobilization in preference to removable splints when using non-operative treatment for the management of displaced distal radius fractures. (Inconclusive)
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8. The use of removable splints is an option when treating minimally displaced distal radius fractures. (Limited)
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9. We are unable to recommend for or against immobilization of the elbow in patients treated with cast immobilization. (Inconclusive)
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10. Arthroscopic evaluation of the articular surface is an option during operative treatment of intra-articular distal radius fractures. (Limited)
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11. Operative treatment of associated ligament injuries (SLIL injuries, LT, or TFCC tears) at the time of radius fixation is an option. (Limited)
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12. Arthroscopy is an option in patients with distal radius intra articular fractures to improve diagnostic accuracy for wrist ligament injuries, and CT is an option to improve diagnostic accuracy for patterns of intra-articular fractures. (Limited)
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13. We are unable to recommend for or against the use of supplemental bone grafts or substitutes when using locking plates. (Inconclusive)
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14. We are unable to recommend for or against the use of bone graft (autograft or allograft) or bone graft substitutes for the filling of a bone void as an adjunct to other operative treatments. (Inconclusive)
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15. In the absence of reliable evidence, it is the opinion of the work group that distal radius fractures that are treated non-operatively be followed by ongoing radiographic evaluation for 3 weeks and at cessation of immobilization. (Consensus)
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16. We are unable to recommend whether two or three Kirschner wires should be used for distal radius fracture fixation. (Inconclusive)
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17. We are unable to recommend for or against using the occurrence of distal radius fractures to predict future fragility fractures. (Inconclusive)
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18. We are unable to recommend for or against concurrent surgical treatment of distal radioulnar joint instability in patients with operatively treated distal radius fractures. (Inconclusive)
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19. We suggest that all patients with distal radius fractures receive a post-reduction true lateral x-ray of the carpus to assess DRUJ alignment. (Moderate)
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20. In the absence of reliable evidence, it is the opinion of the work group that all patients with distal radius fractures and unremitting pain during follow-up be reevaluated. (Consensus)
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21. A home exercise program is an option for patients prescribed therapy after distal radius fracture. (Limited)
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22. In the absence of reliable evidence, it is the opinion of the work group that patients perform active finger motion exercises following diagnosis of distal radius fractures. (Consensus)
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23. We suggest that patients do not need to begin early wrist motion routinely following stable fracture fixation. (Moderate)
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24. In order to limit complications when using external fixation, it is an option to limit the duration of fixation. (Limited)
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25. We are unable to recommend for or against over-distraction of the wrist when using an external fixator. (Inconclusive)
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26. We suggest adjuvant treatment of distal radius fractures with Vitamin C for the prevention of disproportionate pain. (Moderate)
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27. Ultrasound and/or ice are options for adjuvant treatment of distal radius fractures. (Limited)
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28. We are unable to recommend for or against fixation of ulnar styloid fractures associated with distal radius fractures. (Inconclusive)
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29. We are unable to recommend for or against using external fixation alone for the management of distal radius fractures where there is depressed lunate fossa or 4- part fracture (sagittal split). (Inconclusive)
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Recommendation Grading

Overview

Title

Treatment of Distal Radius Fractures

Authoring Organization

American Academy of Orthopaedic Surgeons

Publication Month/Year

December 5, 2009

Last Updated Month/Year

January 4, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Adult, Older adult

Health Care Settings

Ambulatory, Emergency care, Hospital, Long term care, Operating and recovery room, Outpatient

Intended Users

Physical therapist, occupational therapist, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Rehabilitation, Treatment

Keywords

radius fracture, distal radius fracture