The American Academy of Orthopaedic Surgeons (AAOS) and the American Society for Surgery of the Hand (ASSH) released an updated CPG to assist healthcare professionals with developing their own evidence-based approach to diagnosing and treating distal radius fractures in adult patients (>18 years). The scope of the guideline is limited to the treatment of acute distal radius fractures and does not address distal radius malunion.

Overview
Distal radial fractures are the most commonly encountered fractures in trauma patients, with an incidence of 160 to 320 per 100,000 patients annually, and they account for 18% of all fractures[1][2][3]. This new CPG serves as a point of reference and an educational tool for both primary care physicians and orthopaedic surgeons, streamlining possible treatment processes for this common bone injury.

CPG Highlights
With strong or moderate evidence, this updated CPG suggests:

• No difference in outcomes between use of arthroscopic assistance and no arthroscopic assistance when treating patients for distal radius fractures.
• For non-geriatric patients (most commonly defined in studies as under 65 years of age), operative treatment for fractures with post reduction radial shortening >3mm, dorsal tilt >10 degrees, or intraarticular displacement or step off >2 mm leads to improved radiographic and patient reported outcomes.
• Operative treatment for geriatric patients (most commonly defined in studies as 65 years of age and older) does not lead to improved long-term patient reported outcomes compared to non-operative treatment.
• No significant difference in radiographic or patient-reported outcomes between fixation techniques for complete articular or unstable distal radius fractures, although volar locking plates lead to earlier recovery of function in the short term (three months).

In the absence of sufficient evidence specific to distal radius fractures, the CPG workgroup notes that opioid sparing and multimodal pain management strategies should be considered for patients undergoing treatment for distal radius fractures. Further, limited evidence suggests no difference in outcomes based on frequency of radiographic evaluation for patients treated for distal radius fractures.

For More Information
The evidence-based guideline offers accepted approaches to treatment and/or diagnosis and is not intended to be a fixed protocol. Patient care and treatment should always be based on a clinician’s independent medical judgment, giving the individual patient’s specific clinical circumstances.

The full CPG for the management of distal radius fractures is available through AAOS’ OrthoGuidelines website and free mobile app. For more information on the development process for AAOS clinical practice guidelines and their role in providing patients the highest quality of care, please reference the Clinical Practice Guideline Methodology.

# # #

[1] Centraal Bureau voor de Statistiek. Medisch Specialistische Zorg; pati ̈enten,diagnose, zorgtype, 2008-2011. 2017 Nov 10. https://statline.cbs.nl/Statweb/publication/?DM=SLNL&PA=82067ned&D1=3&D2=0&D3=0-19&D4=l&D5=74,149&D6=4&VW=T. Accessed 2019 Jan 28.

[2] Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury.2006 Aug;37(8):691-7. Epub 2006 Jun 30.

[3] Karl JW, Olson PR, Rosenwasser MP. The epidemiology of upper extremity frac-tures in the United States, 2009. J Orthop Trauma. 2015 Aug;29(8):e242-4.