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Review Article
- Nonoperative management of distal radius fractures: when and how?
- Shin Woo Choi, Jae Kwang Kim
- J Musculoskelet Trauma 2026;39(2):93-102. Published online March 10, 2026
- DOI: https://doi.org/10.12671/jmt.2026.00024
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Abstract
PDF - Distal radius fractures are among the most common injuries of the upper extremity, particularly in the elderly population. Although the use of volar locking plate fixation has increased in recent years, evidence from randomized and prospective studies demonstrates that, while operative treatment may achieve superior radiographic alignment and enable more rapid early recovery, these advantages tend to diminish over time and do not result in superior long-term patient-reported functional outcomes in elderly patients. In addition, radiographic parameters show only a limited correlation with functional recovery. Consequently, nonoperative treatment remains a valid and important treatment option for distal radius fractures. The decision to pursue nonoperative management should be based on a comprehensive assessment of radiographic parameters—including dorsal tilt, radial shortening, and intraarticular displacement—together with patient-specific factors such as age, activity level, comorbidities, and functional expectations. For stable or minimally displaced fractures, an immobilization period of 3‒4 weeks is generally recommended, whereas displaced fractures typically require immobilization for 5‒6 weeks. In cases requiring manual reduction, traditional treatment protocols recommend weekly radiographic follow-up during the first 2‒3 weeks to monitor for secondary displacement. Successful nonoperative management should also emphasize effective swelling control through limb elevation, as well as the initiation of early finger exercises to prevent hand stiffness. After removal of the cast or splint, active wrist mobilization is essential for restoring optimal range of motion and achieving functional recovery.
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