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Distal radius fracture


Key sources

The following summarized guidelines for the evaluation and management of distal radius fracture are prepared by our editorial team based on guidelines from the Surgical Infection Society Europe (SIS-E/GAIS/WSES/WSIS/AAST 2024), the Eastern Association for the Surgery of Trauma (EAST/AOTA 2023), the American Academy of Orthopaedic Surgeons (AAOS 2020,2011), the American College of Radiology (ACR 2019), the British Society for Surgery ...
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Diagnostic investigations

Diagnostic imaging: as per ACR 2019 guidelines, obtain wrist X-ray as the initial imaging in adult patients with acute blunt or penetrating trauma to the hand or wrist.
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Diagnostic procedures

Diagnostic arthroscopy: as per AAOS 2011 guidelines, consider performing arthroscopy to improve diagnostic accuracy for wrist ligament injuries in patients with distal radius intra-articular fractures.

Medical management

Pain management
As per AOTA/EAST 2023 guidelines:
Consider administering NSAIDs (such as ketorolac) for pain management in adult patients with a traumatic fracture.
Insufficient evidence to recommend the preferential use of either selective NSAIDs (COX-2 inhibitors) or nonselective NSAIDs.

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  • Antibiotic prophylaxis

Nonpharmacologic interventions

As per AAOS 2011 guidelines:
Insufficient evidence to recommend for or against casting as definitive treatment for unstable fractures that are initially adequately reduced.
Insufficient evidence to recommend for or against immobilization of the elbow in patients treated with cast immobilization.

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  • Splinting

  • Exercise programs

  • Adjuvant therapies

Therapeutic procedures

Closed reduction
As per BOA/BSSH 2018 guidelines:
Avoid performing manipulation in ≥ 65 years old patients with moderately displaced DRFs.
Consider offering nonoperative treatment as a primary treatment for displaced DRF in ≥ 65 years old patients. Take other factors, such as pre-injury function, medical comorbidities, and fracture characteristics, into consideration and discuss options with the patient.

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  • Low-intensity pulsed ultrasound

Surgical interventions

Indications for surgical reduction and fixation
As per AAOS 2020 guidelines:
Consider performing surgery to improve radiographic and patient-reported outcomes in non-geriatric patients (< 65 years of age) with fractures with post-reduction radial shortening > 3 mm, dorsal tilt > 10 degrees, or intra-articular displacement or step off > 2 mm.
Recognize that operative treatment compared to nonoperative treatment does not lead to improved long-term patient-reported outcomes in geriatric patients (≥ 65 years of age).

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  • Anesthesia

  • Technical considerations for surgery

  • Arthroscopic assistance

  • Nerve decompression

Follow-up and surveillance

Follow-up: as per AAOS 2020 guidelines, recognize that there is no difference in outcomes based on frequency of radiographic evaluation in patients treated for DRFs.