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Treatment of Distal Radius Fractures

From the Department of Orthopaedic Surgery, University of North Texas Health Science Center, and the Department of Orthopaedic Surgery, John Peter Smith Hospital, Fort Worth, TX (Dr. Lichtman); the Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, IL (Dr. Bindra); the Department of Orthopedic Surgery, Washington University Affiliated Hospitals, Washington University School of Medicine, St. Louis, MO (Dr. Boyer); the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN (Dr. Putnam); Massachusetts General Hospital Hand and Upper Extremity Service, Boston, MA (Dr. Ring); the Slutsky Hand and Wrist Institute, Torrance, CA (Dr. Slutsky); The Philadelphia and South Jersey Hand Centers, Philadelphia, PA (Dr. Taras); the Bone and Joint Clinic of Houston, Houston, TX (Dr. Watters); the Skeletal Dysplasia Clinic, Department of Orthopaedics, Seattle Children’s Hospital, Seattle, WA (Dr. Goldberg); MetroHealth Medical Center, Cleveland, OH (Dr. Keith); and the Department of Research and Scientific Affairs, (Dr. Turkelson, Ms. Wies, Mr. Boyer, Ms. Hitchcock, Ms. Raymond) and the Department of Medical Affairs (Dr. Haralson), American Academy of Orthopaedic Surgeons, Rosemont, IL.

Dr. Lichtman or an immediate family member serves as a board member, owner, officer, or committee member of the Society of Medical Consultants to the Armed Forces. Dr. Bindra or an immediate family member has received royalties from Tornier, is a member of a speakers bureau or has made paid presentations on behalf of Small Bone Innovations and Integra NeuroSciences, and serves as a consultant to or is a paid employee of Tornier and Integra Neurosciences. Dr. Boyer or an immediate family member serves as a paid consultant to or is an employee of MiMedX Group and OrthoHelix Surgical Designs, serves as an unpaid consultant to Pfizer and Synthes, has stock or stock options held in MiMedX Group and OrthoHelix Surgical Designs, and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from Synthes. Dr. Putnam or an immediate family member has received royalties from Small Bone Innovations; is a member of a speakers bureau or has made paid presentations on behalf of Wright Medical Technology; serves as a paid consultant to or is an employee of Wright Medical Technology; has received research or institutional support from Biomet, Medtronic Sofamor Danek, Synthes, and Zimmer; and has stock or stock options held in Amgen, Biomet, Merck, Stryker, Wright Medical Technology, Boundary Medical, and MedConnections. Dr. Ring or an immediate family member has received royalties from DePuy and Wright Medical Technology; serves as a paid consultant to or is an employee of Acumed and Wright Medical Technology; has received research or institutional support from Acumed, Biomet, Stryker, Tornier, and Joint Active Systems; and has stock or stock options held in MiMedX Group and Illuminoss Medical. Dr. Taras or an immediate family member serves as a board member, owner, officer, or committee member of Union Surgical, is a member of a speakers bureau or has made paid presentations on behalf of Integra Life Sciences, and has received research or institutional support from AxoGen. Dr. Watters or an immediate family member serves as a board member, owner, officer, or committee member of the North American Spine Society, American Board of Spine Surgery, Board of Advisors for the Official Disability Guidelines, and Med Center Ambulatory Surgery Center; is a member of a speakers bureau or has made paid presentations on behalf of Stryker and Synthes; serves as a paid consultant to or is an employee of Orthofix and Stryker; and has stock or stock options held in Intrinsic Therapeutics. Ms. Wies or an immediate family member has stock or stock options held in Shering Plough. Dr. Haralson or an immediate family member serves as a paid consultant to or is an employee of Medtronic and Medtronic Sofamor Danek and has stock or stock options held in Orthofix and AllMeds. None of the following authors nor any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Slutsky, Dr. Goldberg, Dr. Keith, Dr. Turkelson, Mr. Boyer, Ms. Hitchcock, and Ms. Raymond.

The clinical practice guideline is based on a systematic review of published studies on the treatment of distal radius fractures in adults. None of the 29 recommendations made by the work group was graded as strong; most are graded as inconclusive or consensus; seven are graded as weak. The remaining five moderate-strength recommendations include surgical fixation, rather than cast fixation, for fractures with postreduction radial shortening >3 mm, dorsal tilt >10°, or intra-articular displacement or step-off >2 mm; use of rigid immobilization rather than removable splints for nonsurgical treatment; making a postreduction true lateral radiograph of the carpus to assess dorsal radial ulnar joint alignment; beginning early wrist motion following stable fixation; and recommending adjuvant treatment with vitamin C to prevent disproportionate pain.