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

Abstract

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.

Short and long-arm fiberglass cast immobilization for displaced distal forearm fractures in children: a randomized controlled trial

“…Fracture stabilization in this study was high, with a LOR rate of 21% with no significant differences between the two cast groups. These results corroborate the conclusions of previous studies [7][8][9][10][11]. Gold-standard immobilization for such fractures is a molded plaster of Paris cast, which has a reported LOR rate between 12% and 34% [1, 2].…”

“…Fracture immobilization in children is usually managed with upper-arm plaster of Paris casts or FG casts. Long-arm casts (LACs) are mostly recommended for reduced DFF treatment because they prevent pronation and supination movement [7][8][9][10][11]. However, short-arm casts (SACs) are easier to apply, result in fewer restrictions for activities of daily life (ADL), and cause less elbow stiffness [12].…”

“…However, short-arm casts (SACs) are easier to apply, result in fewer restrictions for activities of daily life (ADL), and cause less elbow stiffness [12]. Studies comparing above-and below-elbow plaster of Paris casts concluded that SACs seemed to be as effective as LACs in stabilizing fractures [7][8][9][10][11].…”

Application of 3D-Printed Orthopedic Cast for the Treatment of Forearm Fractures: Finite Element Analysis and Comparative Clinical Assessment

“…Compared with that in group A, the pink skin was more common in groups B and C often found in those regions with high local pressure and motion-related scratch. Proper and early functional exercise might have rehabilitation benefits to restore the function of the wrist for patients with distal forearm fractures [ 13 , 30 ]. Given that the Velcro straps were adopted as fixation straps, it was convenient to adjust, disassemble, and assemble the 3D-printed cast.…”

“…Forearm fractures are common skeletal injuries and occur at all ages especially in children and in the elderly, and distal radius fractures are the most common type [ 11 , 12 ]. Cast immobilization is preferred in the majority of patients with nonsurgically treated forearm fractures [ 13 ]. Poor ventilation and improper fit present in traditional casts are associated with treatment complications.…”