Literature Review of Postoperative Distal Radius Fracture Immobilization Recommendations

TL;DR

This paper reviews post-surgery immobilization methods for wrist fractures to determine which approaches best preserve motion and quality of life.

Contribution

The paper systematically analyzes postoperative immobilization recommendations for distal radius fractures in non-pediatric patients.

Findings

Postoperative immobilization methods vary widely and impact long-term patient outcomes.

There is debate over whether immobilization provides clinical benefit in adult DRFs.

Outcomes depend on fixation types like volar or dorsal locking plates.

Abstract

Distal radius fractures (DRFs) are a commonly treated injury in orthopedics. DRFs have a high incidence across patient demographics, including pediatrics, young patients in high-energy trauma, and geriatric patients in low-energy trauma. While DRFs occur across a large range of age groups, they are especially consequential in geriatric patients with osteoporosis. Management of DRFs has extensive variability, ranging from conservative casting to surgical interventions, such as open reduction and internal fixation surgical procedures. The diversity of treatment options for DRFs is due to a consideration of factors, such as fracture characteristics, time to presentation with an orthopedic surgeon, age of the patient, and medical comorbidities of the patient. Despite being a common fracture type, there remain discrepancies in the non-pediatric literature regarding postoperative recommendations, such as the timing and methods of immobilization. There is also debate regarding whether postoperative immobilization in adult DRFs has clinical benefit. Some of this variability depends on the type of fixation utilized, such as a volar locking plate, dorsal locking plate, and dorsal wrist-spanning fixation. This literature review examines recommendations and outcomes of postoperative splinting (supination, pronation, or neutral rotation of the forearm) versus removable wrist brace versus soft dressings only for DRFs with both intra-articular and extra-articular fracture patterns with operative fixation. Postoperative care is imperative to study as it carries long-term effects on patients’ quality of life, as their range of motion and strength can be dictated by the methodology of this care. Studies have been conducted comparing the outcomes of early mobilization versus prolonged immobilization after surgical intervention. This literature review analyzes these studies to understand which methods carry better outcomes with respect to the range of motion and quality of life of patients for operatively treated DRFs in non-pediatric patients.