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

Okamura, Aldo; Mendonça, Gabriel Maciel de; Neto, Jorge Raduan; Moraes, Vinícius Ynoe de; Faloppa, Flávio; Belloti, João Carlos

doi:10.1186/s12891-018-2007-9

Cited by 8 publications

(7 citation statements)

References 38 publications

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“…Our study strengths are: 1) an a priori protocol [ 21 ] and registration; 2) the only RCT that uses DASH as the primary outcome throughout treatment; 3) a reasonable sample size; 4) low follow-up losses; 5) broad inclusion criteria (stable and unstable fractures); 6) inclusion of functional and surrogate outcomes (PRWE, ROM, radiographical measures, VAS); 7) blinded assessments; and 8) external, public funding (no COI from industry). Study limitations include: 1) consideration of both extra-articular and intra-articular fractures together; 2) the possible need for longer follow-up to assess articular degenerative disease; 3) non-everyday methods for fracture reductions were performed in the operating room; 4) our results may not be applicable for young, active adults; 5) this was a single-center study; and 6) change of the primary outcome during recruitment phase in relation to the published protocol and registration of the research.…”

Section: Discussionmentioning

confidence: 99%

“…The protocol was under an identifier number–NCT03126175 (ClinicalTrials.gov), registered in April 2017. Publication of the protocol in March 2018 [ 21 ]. Patients were recruited between April 2018 and June 2019 and last follow-ups carried out on Dec 2019.…”

Section: Methodsmentioning

confidence: 99%

“…Patients without a reducible distal radius fracture by closed method were excluded from the study and have received surgical treatment on a date to be scheduled. The details can be found elsewhere [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

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No benefit for elbow blocking on conservative treatment of distal radius fractures: A 6-month randomized controlled trial

et al. 2021

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Purpose For displaced distal radius fracture, this trial aimed to compare an above-elbow (AE) and below-elbow (BE) cast at the end of a 24-week follow-up using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as a primary outcome. Methods This is a clinical trial with parallel groups (1:1) and a blinded evaluator. There are two non-surgical interventions: AE and BE. A total of 128 adult patients with acute (up to 7 days) displaced distal radius fracture of type A2-3, C1-3 by the AO classification were included. The follow-up was 24 weeks. The primary outcome was the DASH questionnaire at 24 weeks. Secondary outcomes were the maintenance of reduction by the evaluation of radiographic parameters, pain measured by VAS, PRWE, objective functional evaluation and rate of adverse effects. Results The difference between the two groups in the DASH score at 24 weeks was not significant, with the mean (95% CI) DASH score being AE: 9.44 (2.70 to 16.17) vs. BE: 9.88 (3.19 to 16.57) (p = 0.895). The above-elbow group had a significantly greater worsening of the mean DASH score from baseline to 2 weeks (p < 0.001). No statistically significant differences were found between the 2 groups in any of the other follow-up assessments. Objective functional evaluation, PRWE, radiographical measures and rates of reduction loss were similar between groups. Above-elbow casting resulted in more adverse effects (mostly shoulder pain; 19 events vs. 9 events); RR = 0.39 (0.19–0.94); p = 0.033 at the end of six-month follow-up. Conclusions This study did not demonstrate a difference between above-elbow and below-elbow cast in terms of DASH outcome at 6 months in non-surgical treatment of deviated distal radius fractures. However, below-elbow casting is less debilitating during the treatment period, has comparable performance in maintaining the reduction, and is related to fewer minor adverse effects than above-elbow casting.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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No benefit for elbow blocking on conservative treatment of distal radius fractures: A 6-month randomized controlled trial

et al. 2021

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“…One of the most prevalent fractures in older patients is distal radius fracture, which accounts for about 17% of skeletal fractures 16,17 . Numerous studies have demonstrated that distal radius anatomic repair is important for appropriate functional outcomes [18][19][20] .…”

Section: Discussionmentioning

confidence: 99%

Radiological and Functional Outcome of Distal Radius Fracture treated conservatively vs Percutaneous K-wire fixation

Raza¹,

Saleem²,

Chaudhry³

et al. 2021

PJMHS

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Aim: To compare the radiological and functional result of conservatively treated distant radius fractures (manipulation under anesthesia and plaster of paris) versus percutaneous K- wire fixation Study design: Retrospective Duration and place of study: Department of Orthopedic Surgery, The Indus Hospital, Raiwind campus Lahore from July 2018 to August 2020. Methods: The sample size of 100 patients aged between 18-60 years, closed, isolated distal radius fracture were included, and patients with diabetes mellitus, ischemic heart disease, pathological fractures, chronic renal disease, head injury, chronic liver disease, whose Glasgow coma scale was <14, malignancy were excluded. Patients were randomized as A & B by lottery method. They managed with conservative treatment ( manipulation under anesthesia (MUA) and plaster of paris (POP) cast) and K- wire fixation in groups A & B, respectively. Side of the fractured bone, infection, radiological union, and function outcome were recorded. Results: Amongst the total 100 patients in group-A, 32(63.8%) were males, and 18(36.2%) were females, and 35 (70.2%) were males, and 15 (29.8%) were females in Group-B. in group A patients mean age was 38.86.19 years, while patients mean age of the group B was 39.57.36 years. With the conservative method, 45(95.7%), the union rate was while with the K- wire fixation method, the union rate was 48(96%). In group-A, 35(70%) had excellent, 10 (20%) good, 03 (6%) had an average, and 2(4%) poor and in group-B, 40(80%) had excellent, 04 (08%) good, 04(08%) had an average, and 02 (4%) poor functional outcome. Conclusion: In terms of clinical and radiological evaluation, fixation of a distal radius fracture with K-wires has a better outcome than conservative treatment (MUA and POP cast) with a low infection rate and better union and result. Keywords: closed fracture, distal radius, back slab, K-wires

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“…In the case of a closed reduction followed by cast immobilisation, loss of reduction and stability can occur without being noticed until the cast is removed. If the fracture has united in a mal-aligned or un-desired orientation, it can result in poor clinical outcomes in the long-term 1 . Nonetheless, closed reduction is still the primary choice of treatment for most surgeons since it is minimally invasive, cost-effective and continues to result in good clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Distal Radial Fracture Fixation in Adults using Intramedullary Elastic Wires Augmented with either Cast Immobilisation or External Fixation

Gadegone¹,

Gadegone²,

Lokhande³

et al. 2021

Malays Orthop J

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Introduction: The aim of this study was to evaluate the clinical outcomes following treatment of distal radial fractures using intramedullary elastic wires with a combination of either cast immobilisation or external fixation. Materials and methods: A total of 42 patients (24 females and 18 males) aged 40 to 78 years who presented with displaced and unstable, closed or grade I open, extra- and/or intra-articular fractures of the distal radius were included in the study. Twenty-seven fractures were AO/OTA Type A2-A3 and 15 Type C1-C2. Twenty-four patients were treated with antegrade intramedullary (IM) fixation with elastic wires followed by cast immobilisation and 18 required an external fixator in lieu of casting. Results: Final follow-up evaluation was conducted 12 months post-surgery using Sarmiento's modification of Lindstrom criteria and the demerit point system of Gartland and Werley. Successful fracture union was observed in all patients between eight to 14 weeks. Using Sarmiento's modification of Lindstrom criteria, 12 patients (28.6%) had excellent, 23 (54.8%) had good and 7 (16.6 %) had fair results. Based on the functional evaluation using the demerit point system of Gartland and Werley, 13 patients (31%) had excellent, 25 (59.5%) had good and four (9.5%) had fair results. None of the patients had a poor outcome using either of these criteria. Although a fracture union rate of 100% was confirmed clinically and radiographically, eight out of the 42 patients had minor complications in our study. One patient had uneventful IM migration of the wires, one patient reported a feeling of wire loosening, three patients complained of joint stiffness and soft tissue irritation, and three others reported on-going pain. The total cost of all implants used per case was less than INR 1,000. Conclusions: Good to excellent functional and radiographic outcomes with easy to manage complications are achieved with the techniques described. Patient selection is key to determining which particular method should be prescribed in a given case.

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

Cited by 8 publications

References 38 publications

No benefit for elbow blocking on conservative treatment of distal radius fractures: A 6-month randomized controlled trial

No benefit for elbow blocking on conservative treatment of distal radius fractures: A 6-month randomized controlled trial

Radiological and Functional Outcome of Distal Radius Fracture treated conservatively vs Percutaneous K-wire fixation

Distal Radial Fracture Fixation in Adults using Intramedullary Elastic Wires Augmented with either Cast Immobilisation or External Fixation

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