The American Academy of Orthopaedic Surgeons (AAOS) has released an evidence-based clinical practice guideline focusing on distal radius fractures for use by both primary-care practitioners and orthopedic surgeons. The guideline is available online at www.aaos.org/guidelines.
Although the AAOS acknowledges the need for better studies to precisely determine which treatments work best under different clinical circumstances, they established 29 new recommendations, including the following:
If the fracture is not displaced (e.g., a hairline crack), the patient can wear a removable splint.
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For any fracture that is displaced, a rigid cast is better than a splint.
Fractures that tend to fall back to the way they were before the clinician fixed them may heal better with surgery rather than with a cast.
Certain recommendations lack scientific support but were developed through a consensus among the AAOS work group:
Distal radius fractures treated without surgery should be x-rayed repeatedly for three weeks and when the person stops using the splint or cast.
The patient should perform active finger motion exercises once the fracture has been diagnosed.
Clinicians should promptly re-evaluate a patient with distal radius fracture and unremitting pain.
One way to reduce wrist fractures among older patients is to remind them to use caution when stepping into or out of an elevator. In what is being billed as the first large-scale epidemiologic study of elevator-related injuries in older adults in the United States, researchers identified 44,870 such injuries among this population (mean age: 79.5 years), more than half of which were caused by a slip, trip, or fall ( J Trauma. 2010;68:188-192). n
