Distal radius fractureMANAGEMENT

TRAUMA PRESENTATIONS · 12 SECTIONS

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490 items

☷ Legend

01Approach to the Critical Patient/attcp46

Triage and immediate threats

›High-risk features

›Open fracture

›Visible bone or deep wound over fracture

›Gross contamination

›Neurovascular compromise

›Pulseless or delayed capillary refill

›Progressive paresthesia or weakness

›Compartment syndrome concern

›Escalating pain out of proportion

›Pain with passive finger stretch

›Threatened skin

›Tenting

›Impending volar skin necrosis

›Polytrauma or high-energy mechanism

›Fall from height

›Motor vehicle collision

›Immediate actions

›If pulseless hand or rapidly worsening neuro exam, immediate reduction attempt (Class I consensus)

›Document pre-reduction neurovascular status

›Post-reduction pulse and perfusion reassessment

›If open fracture, antibiotics and urgent orthopedics (Class I consensus)

›Tetanus status update

›Sterile dressing and splinting

›If severe deformity with skin compromise, urgent reduction and splint (Class I consensus)

›Finger trap traction or manual traction technique

›Repeat skin check after splinting

›Analgesia and sedation planning

›Pain control pathway

›Oral analgesia for mild pain

›IV opioids for severe pain or reduction

›Regional anesthesia options for reduction

›Hematoma block option

›Bier block option for dorsally displaced DRF in adults (NICE NG38)

›Sedation safety framework

›ED procedural sedation by trained clinicians supported by ACEP policy (ACEP policy statement)

›Dedicated monitoring and airway readiness for moderate to deep sedation

›Monitoring targets

›Perfusion targets

›Warm, well-perfused hand

›Capillary refill normalizing

›Neuro targets

›Median nerve symptom improvement or stability

›Ulnar and radial nerve stability

›Splint safety targets

›No circumferential constriction

›Swelling accommodation

02History/hx38

Injury context

›Mechanism

›FOOSH

›Wrist extended with dorsal displacement pattern

›Wrist flexed with volar displacement pattern

›High-energy trauma

›Motor vehicle collision

›Sports collision

›Direct blow

›Assault

›Industrial injury

›Timing

›Time since injury

›Evolution of pain and swelling

›Hand dominance

›Dominant wrist involvement

›Functional impact at school or work

›Symptoms suggesting complications

›Numbness or tingling

›Median nerve distribution

›Ulnar nerve distribution

›Weak grip or finger flexion weakness

›Severe pain with finger motion

›Cold hand or color change

Patient factors

›Bone health risk

›Prior fragility fracture

›Osteoporosis diagnosis

›Chronic steroid use

›Bleeding and anticoagulation

›Warfarin

›DOACs

›Antiplatelet therapy

›Comorbidities affecting healing

›Diabetes

›Smoking or vaping

›Peripheral vascular disease

›Infection risk for open injury

›Immunosuppression

›Dirty wound exposure

03Physical Exam/exam43

Focused wrist and hand exam

›Inspection

›Deformity pattern

›Dinner fork appearance

›Volar angulation

›Swelling and ecchymosis

›Skin integrity

›Open wound

›Tenting

›Palpation

›Distal radius tenderness

›Distal ulna tenderness

›DRUJ tenderness

›Snuffbox tenderness for scaphoid concern

›Range of motion limits

›Wrist motion limited by pain

›Finger range of motion preserved or limited

Neurovascular exam

›Vascular

›Radial pulse

›Ulnar pulse if palpable

›Capillary refill

›Hand temperature and color

›Neurologic

›Median nerve

›Thumb opposition strength

›Sensation index fingertip

›Ulnar nerve

›Finger abduction strength

›Sensation small fingertip

›Radial nerve

›Wrist and finger extension strength

›Sensation dorsal first web space

›Compartment syndrome screen

›Pain with passive finger extension

›Tense forearm compartments

›Worsening pain after splinting

Associated injuries screen

›Elbow

›Radial head tenderness

›Elbow range of motion

›Forearm

›Proximal tenderness

›Interosseous membrane pain

›Shoulder

›Proximal humerus tenderness after fall

04Differential Diagnosis/ddx22

Wrist trauma differentials

›Distal radius fracture

›ICD-10 S52.5

›SNOMED CT Distal radius fracture

›Distal ulna fracture

›Ulnar styloid fracture

›Distal ulna metaphysis fracture

›DRUJ injury

›DRUJ instability

›TFCC tear

›Scaphoid fracture

›Occult fracture with snuffbox tenderness

›Perilunate injury

›Carpal instability

›Median nerve symptoms

›Galeazzi fracture-dislocation

›Radius shaft fracture with DRUJ disruption

›Tendon injury

›EPL tendon attrition risk

›Flexor tendon injury with volar wounds

›Vascular injury

›Radial artery injury

›Ulnar artery injury

05Laboratory Tests/lt19

Labs when indicated

›Targeted labs

›Bleeding concern or anticoagulation

›INR for warfarin use

›CBC for significant bleeding or planned surgery

›Open fracture or systemic infection concern

›CBC for systemic infection context

›CRP for suspected deep infection context

›Procedural sedation planning

›Point-of-care glucose for altered mental status risk

›Pregnancy test for pregnancy possibility before radiation or medications

›Lab pitfalls

›Routine labs not required for uncomplicated closed fracture

›Normal labs do not exclude compartment syndrome

Point-of-care testing

›Bedside glucose

›Hypoglycemia exclusion before sedation

›Hyperglycemia recognition for healing risk context

›Pulse oximetry

›Baseline before sedation

›Continuous monitoring during reduction sedation

06Diagnostic Tests/dt74

Scoring Systems

›Classification systems

›AO-OTA distal radius classification

›Extra-articular fractures

›Partial articular fractures

›Complete articular fractures

›Frykman classification

›Radiocarpal involvement

›DRUJ involvement

›Fernandez classification

›Bending fractures

›Shearing fractures

›Compression fractures

›Avulsion fractures

›Combined mechanisms

›Radiographic parameters guiding stability and reduction adequacy

›Radial height and shortening

›Shortening magnitude as instability marker

›Comparison with contralateral side when unclear

›Radial inclination

›Loss suggesting collapse risk

›Post-reduction improvement target

›Volar tilt

›Dorsal tilt as functional risk marker

›Post-reduction alignment target

›Intra-articular step-off and gap

›Step-off threshold for surgical consideration

›Gap threshold for instability consideration

›DRUJ alignment

›Ulnar variance changes

›Sigmoid notch congruity

MRI

›MRI indications

›Persistent pain with normal radiographs and CT negative

›Suspected TFCC tear with DRUJ instability

›Suspected scapholunate or lunotriquetral ligament injury

›MRI limitations

›Limited ED utility for acute management

›Metal artifact after fixation

›MRI outputs

›Bone marrow edema for occult fracture

›Ligament and TFCC integrity

›CT indications

›Suspected intra-articular extension with unclear radiographs

›Surgical planning for comminuted fractures

›Suspected carpal fracture-dislocation with complex anatomy

›CT protocol considerations

›Thin-cut wrist CT for articular surface detail

›3D reconstructions for operative planning

›CT limitations

›Radiation exposure

›Limited soft tissue ligament detail compared with MRI

Ultrasound

›POCUS applications

›Cortical disruption detection when radiographs delayed

›Hematoma visualization for hematoma block guidance

›Median nerve ultrasound for severe carpal tunnel features

›Ultrasound limitations

›Operator dependence

›Limited articular surface assessment

›Doppler use

›Radial and ulnar flow confirmation when pulse exam equivocal

›Post-reduction perfusion verification adjunct

Plain radiography

›X-ray views

›Wrist series

›PA

›Lateral

›Oblique

›Forearm views

›Radius and ulna shafts for associated fractures

›Elbow inclusion when pain or high energy

›Post-reduction imaging

›Immediate post-reduction radiographs

›Post-splint radiographs for maintenance of alignment

›Imaging pitfalls

›Associated scaphoid fracture can be occult early

›DRUJ injury can be missed without clinical correlation

07Disposition/dispo23

Discharge criteria

›Safe outpatient pathway

›Closed fracture

›Intact neurovascular exam after splint

›Pain controlled with oral regimen

›Acceptable alignment or stable immobilization plan with urgent follow-up

›Reliable follow-up and return precautions understanding

›Follow-up timing

›Fracture clinic or orthopedics within 72 hours target in many pathways (BOAST 16)

›Repeat radiographs within 7 to 10 days for displacement risk

›Discharge immobilization

›Sugar-tong or reverse sugar-tong splint for unstable patterns

›Volar splint for stable, minimally displaced patterns

›Thumb spica addition if scaphoid concern

Admission or transfer criteria

›Urgent orthopedics

›Open fracture

›Neurovascular compromise not resolved after reduction

›Compartment syndrome concern

›Irreducible fracture or unstable reduction

›Significant intra-articular displacement requiring urgent fixation pathway

›Medical admission considerations

›Frail patient unable to mobilize safely

›Uncontrolled pain despite ED management

›Social barriers preventing safe discharge

08Treatment/t107

Immobilization and reduction strategy

›Initial immobilization

›Splint choice principles

›Swelling accommodation

›Joint immobilization

›Common splints

›Sugar-tong splint

›Forearm rotation control

›Elbow flexion support

›Reverse sugar-tong splint

›Forearm rotation control with elbow range allowance

›Edema accommodation

›Volar splint

›Stable fracture option

›Short-term comfort splint

›Closed reduction indications

›Gross deformity

›Neurovascular compromise

›Threatened skin

›Unacceptable alignment on radiographs

›Closed reduction technique elements

›Traction and countertraction

›Finger trap traction option

›Manual traction option

›Deformity reversal maneuvers

›Dorsal displacement reduction with volar-directed pressure

›Volar displacement reduction with dorsal-directed pressure

›Three-point mold

›Dorsal mold for dorsal angulation patterns

›Volar mold for volar angulation patterns

›Post-reduction care

›Neurovascular recheck immediately

›Compartment syndrome surveillance instructions

›Elevation and finger motion encouragement

Analgesia and anesthesia for reduction

›Non-opioid analgesia

›Acetaminophen PO dosing per local protocol

›NSAID use

›Renal disease caution

›GI bleed risk caution

›Opioid analgesia

›IV opioid titration for reduction pain

›Respiratory monitoring during titration

›Naloxone availability

›Hematoma block

›Local anesthetic selection

›Lidocaine 1% without epinephrine typical

›Bupivacaine option for longer duration

›Dosing safety

›Lidocaine maximum dose per kg reference

›Avoid intravascular injection

›Technique elements

›Sterile prep

›Aspiration for blood return confirmation

›Slow infiltration into fracture hematoma

›Bier block

›Adult dorsally displaced DRF reduction option (NICE NG38)

›Requirements

›Trained clinician

›Tourniquet equipment and monitoring

›Local anesthetic dosing protocol adherence

›Nitrous oxide limitation

›Nitrous oxide and oxygen alone not recommended for adult DRF reduction analgesia (NICE NG38)

›Procedural sedation

›Indications

›Inadequate analgesia with local techniques

›Severe anxiety or inability to cooperate

›Safety and staffing

›Airway equipment readiness

›Continuous monitoring

›Trained personnel consistent with ACEP policy statements

›Medication examples

›Ketamine protocol per local sedation policy

›Dissociative dosing per kg

›Emergence reaction mitigation plan

›Propofol protocol per local sedation policy

›Incremental bolus titration

›Hypotension readiness

Indications for operative management and consultation

›Consultation triggers

›Open fracture

›Urgent operative irrigation and debridement pathway

›IV antibiotics initiation

›Irreducible fracture

›Soft tissue interposition concern

›Tendon entrapment concern

›Unstable fracture pattern

›Comminution

›Marked shortening

›Associated ulnar fracture

›Intra-articular displacement

›Step-off or gap concerning for post-traumatic arthritis risk

›CT consideration for surgical planning

›Acute carpal tunnel syndrome

›Progressive median nerve deficit

›Urgent decompression consideration

›Evidence-based guidance

›AAOS and ASSH distal radius fracture CPG approved Dec 2020

›Operative fixation considerations based on patient function goals, fracture pattern, and alignment parameters

›Shared decision-making emphasis for older adults with low functional demand (AAOS/ASSH)

Medications and prophylaxis

›Antibiotics for open fracture (Class I consensus)

›First-line coverage per local open fracture protocol

›Early administration goal

›Weight-based dosing per local policy

›Soil or farm contamination

›Broader coverage per local protocol

›Tetanus update priority

›Tetanus prophylaxis

›Booster based on immunization status and wound type

›Tetanus immune globulin for incomplete immunization with dirty wound

09Special Populations/sp39

Pregnancy

›Pregnancy considerations

›Radiation minimization

›Shielding for radiographs when feasible

›CT only when clearly needed for management

›Analgesia considerations

›NSAID avoidance in later pregnancy context

›Opioid risk and short-course principle

›Regional anesthesia preference

›Hematoma block consideration to reduce systemic meds

›Avoid hypotension during sedation

›Obstetric consultation triggers

›Trauma with abdominal pain

›Viability concerns

Geriatric

›Geriatric considerations

›Fragility fracture signal

›Osteoporosis assessment and referral pathway

›Fall risk assessment and prevention counseling

›Functional goals focus

›Dominant hand importance

›Independence and mobility impact

›Complication risk

›Loss of reduction risk higher with comminution and osteoporosis

›Skin breakdown risk with tight casts

›Management guidance

›AAOS/ASSH guideline emphasis on shared decision-making in older adults (AAOS/ASSH)

Pediatrics

›Pediatric considerations

›Injury patterns

›Torus fracture

›Greenstick fracture

›Salter-Harris distal radius physeal injury

›Imaging

›Growth plate assessment on radiographs

›Contralateral comparison when uncertain

›Management guidance

›Torus fracture care without rigid cast preferred in many guidelines (NICE NG38)

›Age-dependent acceptable angulation and remodeling potential

›Safeguarding

›Non-accidental injury consideration for inconsistent history

›Documentation of mechanism consistency

10Background/b33

Epidemiology

›Epidemiology facts

›Most common upper extremity fracture site in adults

›Bimodal distribution

›Younger high-energy trauma

›Older low-energy fragility trauma

›Higher incidence in older women

›Postmenopausal bone loss association

›Winter falls association in colder climates

Pathophysiology

›Injury mechanics

›FOOSH load transmission

›Dorsal displacement with wrist extension

›Volar displacement with wrist flexion

›Articular involvement

›Radiocarpal surface disruption

›DRUJ congruity disruption

›Soft tissue injury associations

›TFCC injury with ulnar-sided pain

›Scapholunate ligament injury with carpal instability risk

›Neurovascular complications

›Median nerve compression

›Vascular spasm or injury uncommon but critical

Therapeutic Considerations

›Treatment goals

›Pain control

›Restore alignment when needed

›Maintain reduction during healing

›Preserve function and forearm rotation

›Alignment and function relationship

›Malunion association with reduced wrist motion and grip strength

›Intra-articular incongruity association with arthritis risk

›Evidence-based practice highlights

›AAOS/ASSH CPG emphasizes individualized treatment based on patient factors and fracture characteristics (AAOS/ASSH Dec 2020)

›BOAST emphasizes functional recovery over radiographic perfection (BOAST 16)

›NICE supports Bier block for adult dorsally displaced DRF reduction in ED with trained staff (NICE NG38)

11Patient Discharge Instructions/pdi26

copy discharge instructions

›Distal radius fracture instructions

›Splint care

›Keep splint clean and dry

›Do not remove splint unless instructed

›Check fingers for swelling and color

›Swelling control

›Elevation above heart level as much as possible for 48 to 72 hours

›Frequent finger motion exercises

›Pain control plan

›Acetaminophen as directed

›NSAID if safe for you and approved

›Opioid only if prescribed and only as needed

›Activity limits

›No lifting or weight-bearing with injured wrist

›Avoid getting splint wet

›Follow-up

›Orthopedics or fracture clinic appointment within 72 hours if arranged

›Repeat X-ray within 7 to 10 days if instructed

›Return to ED now for red flags

›Increasing pain not controlled with medication

›Numbness or tingling in fingers

›Fingers becoming pale, blue, cold, or difficult to move

›Severe swelling with tight splint feeling

›New weakness of thumb or fingers

›Fever or worsening redness or drainage from wound

›Wet, broken, or too-tight splint

12References/r20

Guidelines and key sources

›Evidence sources

›AAOS Distal Radius Fractures quality and guideline hub

›AAOS Management of Distal Radius Fractures Evidence-Based Clinical Practice Guideline published Dec 5, 2020

›AAOS Appropriate Use Criteria treatment of distal radius fractures

›AAOS and ASSH CPG summary publication

›AAOS Board approval Dec 2020

›ASSH adoption May 2021

›BOAST 16 Management of Distal Radial Fractures Dec 2017

›Early fracture clinic review within 72 hours recommendation in BOAST pathways

›Surgery timing targets for intra-articular and extra-articular fractures in BOAST pathways

›NICE NG38 Fractures non-complex Feb 2016

›Bier block consideration for adult dorsally displaced DRF reduction in ED

›Nitrous oxide and oxygen alone not recommended for adult DRF reduction

›Torus fracture recommendation avoiding rigid cast

›ACEP procedural sedation policy resources

›Procedural sedation support statement for trained ED clinicians

›Procedural sedation policies and competencies emphasis

›System framework source

›Checkbox-only database-optimized structure requirements

›Subsection container and nesting rules used for this artifact

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.