A controlled prospective study of early mobilization of minimally displaced fractures of the distal radial metaphysis

Davis, T. R. C.; Buchanan, Jamie

doi:10.1016/0020-1383(87)90015-5

Cited by 16 publications

(14 citation statements)

References 3 publications

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“…The radiographic inclusion criteria for the fractures were based on the primary dislocation: moderate dorsal angulation 5–40° from a line perpendicular to the long axis of the radius, axial compression ≤4 mm, intra-articular step-off ≤1 mm and intact ipsilateral ulna (except for processus styloideus ulnae). According to previous studies, fractures with slight dorsal angulation <5° can be treated with early mobilisation [1–3]. These fractures were therefore not included in the study.…”

Section: Methodsmentioning

confidence: 99%

“…This research has shown that treatment with early mobilisation of non-displaced or minimally displaced distal radius fractures largely produces the same radiographic result as conventional plaster cast fixation [1–3]. When slightly displaced distal radius fractures were reduced and randomised to immobilisation in a plaster cast for 3 weeks compared with 5 weeks, early mobilisation did not lead to a greater loss of reduction in two studies [4, 5] but to a slight increase in radial angulation in one study [6].…”

Section: Introductionmentioning

confidence: 99%

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Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study

Christersson

Larsson

Östlund³

et al. 2016

J Orthop Surg Res

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BackgroundThe aim of this study was to examine whether reduced distal radius fractures can be treated with early mobilisation without affecting the radiographic results.MethodsIn a prospective randomised study, 109 patients (mean age 65.8 (range 50–92)) with moderately displaced distal radius fractures were treated with closed reduction and plaster cast fixation for about 10 days (range 8–13 days) followed by randomisation to one of two groups: early mobilisation (n = 54, active group) or continued plaster cast fixation for another 3 weeks (n = 55, control group).ResultsFor three patients in the active group (6%), treatment proved unsuccessful because of severe displacement of the fracture (n = 2) or perceived instability (n = 1). From 10 days to 1 month, i.e. the only period when the treatment differed between the two groups, the active group displaced significantly more in dorsal angulation (4.5°, p < 0.001), radial angulation (2.0°, p < 0.001) and axial compression (0.5 mm, p = 0.01) compared with the control group. However, during the entire study period (i.e. from admission to 12 months), the active group displaced significantly more than the controls only in radial angulation (3.2°, p = 0.002) and axial compression (0.7 mm, p = 0.02).ConclusionsEarly mobilisation 10 days after reduction of moderately displaced distal radius fractures resulted in both an increased number of treatment failures and increased displacement in radial angulation and axial compression as compared with the control group. Mobilisation 10 days after reduction cannot be recommended for the routine treatment of reduced distal radius fractures.Trial registrationClinicalTrail.gov, NCT02798614. Retrospectively registered 16 June 2016.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study

Christersson

Larsson

Östlund³

et al. 2016

J Orthop Surg Res

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“…Data for pain were available in six of the included studies (►Table 2). 6,26,[42][43][44][45] Only one study reported significant difference, without describing mean values. 45 Overall, the reviewed studies showed no difference in pain between Group A or B.…”

Section: Functional Outcomementioning

confidence: 99%

Duration of Cast Immobilization in Distal Radial Fractures: A Systematic Review

et al. 2019

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Objective The duration of immobilization in distal radial fractures is disputed in the current literature. There are still no long-term superior outcomes of operative treatment in comparison to nonoperative treatment. A systematic review was initiated to assess the clinical controversy on the duration of the immobilization period for nonoperatively treated distal radial fractures. Materials and Methods A comprehensive search was performed in the PubMed, Embase, and Wiley/Cochrane Library databases and a manual reference check of the identified systematic reviews and meta-analyses was executed. Eligible studies were randomized controlled trials that compared two periods of immobilization, with reported functional, patient-reported, and radiological outcomes. Two reviewers independently agreed on eligibility, and assessed methodological quality and extracted outcome data. Results The initial search yielded 3.384 studies. Twelve trials, with 1063 patients, were included in this systematic review. Grip strength and patient-reported outcome were better in patients treated by a shorter period of immobilization. There was no difference in pain, range of motion, or radiological outcome between different periods of immobilization. Owing to heterogeneity of studies, data were unsuitable for pooling. Conclusion Included studies showed that there might be a preference for a shorter period of immobilization in nonoperatively treated distal radius fractures. Therefore, shortening the period of immobilization in distal radial fractures to a maximum of three weeks should be considered. Future research should include homogeneous groups of patients to draw valid conclusions on the appropriate period of immobilization for nonoperatively treated distal radial fractures. Level of Evidence This is a Level II study. Systematic Review Registration Number PROSPERO 2018 CRD42018085524.

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“…no difference was noted between the two treatment groups in pain at any follow-up. A few studies have reported decreased pain in early mobilized groups during the early treatment phase (3,6,12), whereas other studies have shown equal levels of pain during the early treatment phase (5,9,14). Almost all studies reporting pain after early mobilization in distal radius fractures have observed similar pain levels between the groups over time (9,11,12).…”

Section: Discussionmentioning

confidence: 99%

“…It therefore seems reasonable to assume that a shorter period of immobilization in a plaster cast of distal radius fractures will result in better functional outcome. Several studies have shown that early mobilization in undisplaced or minimally displaced distal radius fractures leads to the same radiographic results as conventional plaster cast fixation (3)(4)(5). It is also possible to treat reduced distal radius fractures with plaster cast removal at 3 weeks (6,7) or with functional bracing (8)(9)(10)(11)(12), without jeopardizing the fracture position.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcome after Plaster Cast Fixation for 10 Days Versus 1 Month in Reduced Distal Radius Fractures: A Prospective Randomized Study

2017

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Treatment with mobilization 10 days after reduction of moderately displaced distal radius fractures resulted in a few treatment failures compared with none among controls. The only functional benefit for the remaining patients was a small and transient increase in range of motion at the 1-month follow-up. Plaster cast removal 10 days after reduction in moderately displaced distal radius fractures is therefore not recommended.

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A controlled prospective study of early mobilization of minimally displaced fractures of the distal radial metaphysis

Cited by 16 publications

References 3 publications

Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study

Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study

Duration of Cast Immobilization in Distal Radial Fractures: A Systematic Review

Clinical Outcome after Plaster Cast Fixation for 10 Days Versus 1 Month in Reduced Distal Radius Fractures: A Prospective Randomized Study

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