Nonsurgical (Cast) Treatment of Distal Radius Fractures

Treatment of fractures of the distal radius varies greatly depending on age of the patient. Children and young teenagers very seldom require surgery. Very frequently, the fracture may be very minimally displaced (a “buckle fracture”). These very often heal with a brace or a cast for 3 weeks and have no long-lasting problems. A significantly displaced wrist fracture in a child may require a closed reduction of the fracture (manually straightening the bone with the patient under anesthesia), application of a cast, and occasionally insertion of temporary pins to stabilize the fracture until the bone heals (typically 3-6 weeks depending on age of the patient). Treatment of the elderly patient who is not very physically active usually also involves cast application with or without closed reduction.

 

 

 

Example: Closed Reduction (Manipulation) and Cast Treatment of 8-Year-Old Boy with Displaced Distal Radius and Ulna Fractures

  1. Left: X-ray showing “bayonet” apposition of radius and ulna
  2. Center: X-ray immediately following closed reduction
  3. Right: X-ray at 1 month following injury showing significant healing

 

 

 

Example: Displaced Distal Radius Fracture in 89-Year Old Woman Treated by Closed Reduction

  1. Left: Displaced distal radius fracture with gross malalignment
  2. Right:Same fracture after manipulation with much improved position

Surgical Treatment of Distal Radius Fracture

When a fracture is displaced in a younger adult, or when the patient is elderly but physically active, surgery is usually necessary. This typically involves straightening the fracture in the operating room and application of a steel or titanium plate to the palm surface of the wrist. The fracture is usually quite stable after application of such a plate and no cast is necessary unless the fracture is particularly severe or the patient’s bone density is very poor. Hand therapy is sometimes necessary to help adult patients regain motion and strength after these fractures, whether or not surgery was performed.

 

 

 

Example: Displaced Distal Radius Fracture in a 42-Year Old Man, Treated by Plate Fixation

  1. Left: X-ray showing displaced distal radius fracture involving articular (joint) surface
  2. Right: Postop X-ray showing greatly improved joint fragment alignment, fixed with a plate

The most severe fractures may require application of more than one plate (See also: Repair of wrist fractures using fragment-specific fixation) or application of an external fixator, which is a carbon-fiber rod attached by skeletal pins to span the fracture site to keep it from collapsing.

 

Surgical Fixation of Distal Radius Fracture

Nicky Leung, M.D. demonstrates the technique of distal radius ORIF (warning: graphic content).

 

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