Closed reduction and cast immobilization is an important method of treatment of distal radius fracture.
Any successful reduction would require pain relief to overcome muscle spasm.
Most of the reductions in distal radius can be done in Hematoma Block supplemented with sedation or Bier block provides adequate anesthesia in most settings. Few patients may need general anaesthesia.
Reduction
Longitudinal traction is applied on the affected limb while assistant provides countertraction. After that direct pressure is applied on the displaced radial metaphyseal fragment for reduction.
Whenever possible, reduction and cast application should be done under Carm image intensifier control so that reduction can be confirmed. Otherwise reduction should be confirmed using plain x-rays after the maneuver.
Cast Application
The cast provides a dorsal buttress to prevent collapse. Excessive palmar flexion of the radius should be avoided to avoid risk of acute carpal tunnel syndrome. Some authors have suggested placing the radioulnar joint in supination but there is no consensus yet.
Follow Up
Postreduction x-rays are obtained at 7, 14, and 21 days. The postreduction x-rays must be compared with the initial postreduction x-rays to accurately determine redisplacement.
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