Which immobilization is better for distal radius fracture? A prospective randomized trial

• Published in: International orthopaedics 2017-09, Vol.41 (9), p.1723-1727
• Main Authors: Gamba, Carlo, Fernandez, Felipe Andrés Mingo, Llavall, Marta Cuenca, Diez, Xavier Lizano, Perez, Fernando Santana
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Casts, Surgical; Elbow Joint - physiopathology; Emergency Service, Hospital; Female; Fracture Fixation - adverse effects; Fracture Fixation - methods; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Orthopedics; Prospective Studies; Radius Fractures - diagnostic imaging; Radius Fractures - therapy; Range of Motion, Articular; Treatment Outcome
• ISSN: 0341-2695; 1432-5195
• DOI: 10.1007/s00264-017-3518-y

Introduction The aim of this study was to determine whether an above-elbow cast (AEC) is better than a below-elbow cast (BEC) at maintaining the initial reduction in the orthopaedic management of a distal radius fracture (DRF). Methods It is a prospective randomized study carried out in a single emergency trauma department. There were 72 patients older than 55 years of age (55–96) with a distal radius fracture treated orthopaedically. They were randomized into two groups: group B (AEC 32 patients) and group A (BEC 40 patients). Randomization was done by a computer program. Four subgroups were constituted according to the instability criteria: subgroup 4 the most instable fractures. Main outcome was reduction loss from initial reduction to cast removal: it was measured using the volar tilt, radial tilt and radial length on plain radiographs. Results No differences were observed between group A and B when analysed globally (volar tilt loss p  = 0.89 radial tilt loss p  = 0.08 ulnar variance p  = 0.19). Subgroups analysis revealed less radial tilt reduction loss in group A in patients within subgroup 3 ( p  = 0.02) and 4 ( p  = 0.003). Discussion Results are in contrast to what was expected. Limiting prono-supination AEC is supposed to better maintain initial fracture reduction. Effect of pronation and supination as well as distraction of brachioradialis muscle could have been overestimated until now. Conclusion The above-elbow cast is not better than the below-elbow cast in terms of loss reduction. However, the below-elbow cast more efficiently controls radial tilt reduction.