Distal radius fractures often produce a visible deformity, but palpation can be used to confirm the location of the fracture prior to reduction in splinting. The injured arm should be hung from an IV pole using curlex or a set of finger traps. Placing the curlex around the radial digits assists with restoring radial height and inclination. Weights placed through the antecubital fossa provide traction for assistance with reduction. Manual pressure with both thumbs on the distal part of the fracture assists with redirecting fracture fragments. A traction radiograph can then be taken to confirm acceptable alignment of the fracture. Splinting then begins with placement of a base layer of cotton soft roll. Splinting or casting should go as far distal as the metacarpal heads but allow flexion at the metacarpophalangeal joints. We will be demonstrating placement of a sugar tongue splint, although this is not the only option for immobilization. The proximal aspect of the sugar tongue splint includes the elbow. Multiple layers of cotton should be placed at the proximal and distal ends of the splint or cast to provide extra padding. Wrapping then proceeds with 50% overlap of each layer moving proximally. Slight tension is held to ensure smooth layering. Because the elbow is immobilized in the sugar tongue splint, extra cotton padding over the olecranon is necessary to prevent irritation and possible skin breakdown to this bony prominence. A second layer of cotton is then placed for additional padding. Plaster sheets are then sized to the patient's injured arm. 8 to 10 layers of 3 to 4 inch plaster is measured to fit the patient's arm. The plaster should be wide enough to provide support but not so wide as to form a circumferential cast after application. The sugar tongue splint requires plaster from the metacarpal heads to the elbow. The plaster should be thoroughly soaked to allow adhesion of layers and moldability. Excess fluid should be removed to allow the plaster to dry in a timely fashion. Water temperature will affect the speed of plaster hardening with hot water leaving less time for application and molding. The wet plaster is then placed around the elbow to the level of the metacarpal heads both volarly and dorsally, creating a sandwich around the fracture site. One layer of cotton soft roll is then used to secure the plaster. Overlapping is not necessary, however. The plaster should be entirely covered by cotton so as not to create a tourniquet with placement of the outer ace wrap. Finally, an ace wrap with a hole cut for the thumb is placed as the outer layer to hold the splint in place. Care is taken to avoid pulling excessive tension on the ace wrap as this will cause unnecessary, possibly dangerous, amount of compression on the injured forearm. A wrap that is too loose will allow the splint to fall out of place. Tape is then used to secure the ace wrap. At this time, the splint should not yet have hardened. A three-point mold is applied to assist with maintenance of fracture reduction. One point of pressure is held with the palm of the hand or the forearm at the apex of the fracture site to prevent redisplacement with counter pressure proximally and distally on the opposite side of the forearm. A knee or assistant may be needed to provide the third point of pressure. Pressure should be maintained until the plaster is no longer deformable. This may take up to 10 minutes. For more information, visit www.FEMA.gov

reducing distal radius fractures

splinting distal radius fractures

fracture location confirmation

traction radiograph for alignment confirmation

sugar tongue splint application