A prospective randomized controlled trial comparing circumferential casting and splinting in displaced Colles fractures

Abstract

Objective:Our primary objective was to determine the effectiveness of 3 immobilization methods (circumferential casting [CC], volar–dorsal splinting [VDS] and modified sugar-tong [MST] splinting) in maintaining the position of displaced distal radius fractures after successful closed reduction. Our secondary objective was to assess long-term functional outcomes associated with immobilization with fibreglass splinting versus standard CC in patients maintaining initial nonoperative reductions.Methods:We conducted a prospective randomized single-blind controlled trial in patients over 18 years of age who presented to the emergency department with a displaced fracture of the distal radius requiring closed reduction. The primary outcome was loss of reduction (defined as radiologic slippage or the need for surgical fixation during the 3–4 week primary immobilization period after initial successful reduction). Secondary outcomes included DASH (disabilities of the arm, shoulder and hand) score, return to work, activities of daily living, wrist pain, range of motion and grip strength assessed at 8 weeks and 6 months.Results:Thirty participants were randomly assigned to receive MST splinting, 31 to receive VDS and 40 to receive CC. Baseline characteristics were similar among groups. Radiographic loss of reduction occurred in 16% (95% confidence interval [CI] 3.1%–28.9%) of participants in the VDS group, 20% (95% CI 7.6%–32.4%) in the CC group and 30% (95% CI 13.6°%–46.4°%) in the MST splinting group (p= 0.17). Based on multivariate analysis of variance, functional outcomes at 8 weeks were similar among groups (p= 0.89). DASH scores at 8 weeks and 6 months were similar among groups, based on 1-way analysis of variance (p> 0.25).Conclusion:Rates of loss in anatomic position were not statistically significant among the 3 types of dressings used. However, there was a clinically important trend of increased loss of reduction with the use of MST splinting. Functional outcomes at 8 weeks and 6 months were not significantly different between CC, VDS and MDS splinting. Ease of application and familiarity with use should guide clinical decisions when choosing a dressing type for displaced Colles fractures.

Above-versus below-elbow casting for conservative treatment of distal radius fractures: a randomized controlled trial and study protocol

“…Casts that include the elbow joint, which prevents the rotation of the forearm, may result in greater stability of the fracture and less risk of loss of reduction and need for re-reduction [ 10 – 12 ]. Other studies found similar results between immobilization methods in maintaining the initial fracture reduction [ 13 , 14 ].…”

Management of distal radius fractures in emergency departments in England and Wales

“…With respect to plaster techniques, various types have been studied, and overall there does not seem to be any advantage of circumferential casting over other techniques8 in terms of secondary displacement. With 95% of ED using non-circumferential casting, practice appears to be in line with the evidence.…”

“…The type of cast used to hold the reduction has also been a significant source of debate, with early papers advocating the use of sugar tong casts 7. A recent study has shown very little difference in the maintenance of reduction between circumferential and non-circumferential casts 8. Our impression was that there is substantial variation in clinical practice around the country and although there are trends in the evidence, we wanted to know if this has been reflected in clinical practice.…”

Evaluation of the safe zone for percutaneous Kirschner‐wire placement in the distal radius: Cadaveric study

“…Fractures of the distal radius are a common injury requiring orthopedic intervention. There are many (Pradhan et al, 2009;Belloti et al, 2010;Grafstein et al, 2010). Kirchner wires can be used as the sole fixation device (Gradl et al, 2005), or they can be used to supplement other fixation methods for increased stability (Pradhan et al, 2009).…”