Emergency Medicine Management of Distal Radius and Ulna Fractures: Narrative Review.

Abstract

Importance: Distal radius fractures and distal ulna fractures are common orthopedic injuries treated in emergency departments (ED). Our goal in this narrative review was to present emergency physicians with a single source that covers the evaluation and treatment of distal radius fractures and distal ulna fractures across the lifetime of our patients. There are differences in the treatment algorithms for distal radius fractures between pediatric, young adult, and geriatric patients.

Observations: Pediatric distal radius fractures are defined by their relation to the growth plate and are influenced by the gradual calcification of the developing bone. Some pediatric distal radius fractures can heal through significant displacement, while others require anatomical reduction to limit the risk of growth arrest. For adult patients with a distal radius fracture, there are established guidelines for both appropriate reduction goals and for when operative treatment is indicated. For geriatric patients, management strategies have evolved over the last decade after multiple studies demonstrated no functional difference between operative and nonoperative management. Given this, most geriatric distal radius fractures are managed nonsurgically, which makes effective reduction in the ED important to optimize long-term wrist function.

Conclusion and relevance: Emergency physicians need to be well versed at both identifying fracture patterns and be knowledgeable about radiographic fracture-reduction goals. This emergency medicine-focused and illustrated narrative review will assist physicians, nurse practitioners, and physician assistants in meeting those goals. We also summarize pain management, splint molding, possible complications and follow-up considerations for emergency physicians treating patients with distal radius fractures.