Nonoperative treatment

For conservative fracture treatment, a circumferential cast is recommended. The cast material selected does not affect the outcome.

Splinting is usually only used for additional stabilization after ORIF.

The wrist is immobilized in a below-elbow cast, with the wrist neutral to slightly flexed (<15°) for 6 weeks.

Pad the arm and hand to avoid pressure sores, especially on the distal ulna and styloid process of the radius.

Apply the circumferential plaster in a standard manner, starting at the fracture level.

The wrist should be in neutral position or up to 15° palmar flexion.

Make sure that the plaster does not extend too far distally, both at the levels of the metacarpophalangeal joints of the fingers and the interphalangeal joint of the thumb. The cast must allow complete movement of these joints.

The aftercare can be divided into four phases of healing:

• Inflammatory phase (week 1–3)
• Early repair phase (week 4–6)
• Late repair and early tissue remodeling phase (week 7–12)
• Remodeling and reintegration phase (week 13 onwards)

Full details on each phase can be found here.

To facilitate rehabilitation, it is important to control the postoperative pain adequately.

• Management of swelling
• Appropriate splintage
• Appropriate oral analgesia
• Careful consideration of peripheral nerve blockade