A novel method of manipulation and immobilization with the wrist dorsiflexed for distal radius fractures: short-term outcomes

Abstract

Distal radius fractures (DRFs) are the most common fractures in adults. For displaced DRFs, casting after successful closed reduction remains a standard treatment. The optimal wrist position during casting has been discussed extensively, with dorsiflexion shown to help prevent re-displacement after reduction. However, few studies have clearly described the specific techniques for both reduction and dorsiflexion casting. This study aims to describe our combined method of reduction and dorsiflexion casting and to evaluate its effectiveness. This single-center study included patients diagnosed with closed, dorsally displaced DRFs who were treated conservatively between 1 April 2018 and 31 September 2024. Patients aged 17 years or younger and those with intra-articular displacement of 2 mm or more were excluded. All fractures were reduced using finger traps under brachial plexus block and immobilized with casts applied in wrist dorsiflexion. We evaluated X-ray parameters before reduction, after reduction, and at 1 year post-injury, as well as clinical outcomes using the Mayo Wrist Score and QuickDASH. Additionally, we recorded the number of medical staff (doctors, nurses, and others) required to perform the reduction and casting. Fifty patients were included, with a mean age of 69.0 years; 39 were female. All patients achieved acceptable reduction using this combined reduction and casting method. The mean post-manipulation and post-casting values for radial inclination, palmar tilt, and ulnar variance were 24.1°, 10.6°, and 0.1 mm, respectively. All procedures were performed by two staff members (either one doctor and one nurse or two doctors), with reduction and casting carried out by a single physician. No patients required conversion to surgical treatment. At 1 year, the mean Mayo Wrist Score was 91.1, and the mean QuickDASH score was 2.2. In this study, the combination of reduction using finger traps and dorsiflexion casting produced favorable functional outcomes. This technique may represent an effective conservative treatment for DRFs while requiring fewer medical staff to perform the procedure.