The Effect Immobilization Mechanisms Have on Radiographic Outcomes and Complication Rates in the Conservative Treatment of Distal Radius Fractures: A Systematic Review

Jamnik, Adam A.; Chacón, José Arnoby; Xiao, Angel; Wagner, Eric R.; Gottschalk, Michael B.

doi:10.1177/15589447221081864

Cited by 6 publications

(2 citation statements)

References 37 publications

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“…However, although this was not a randomized study, it was observed a tendency of the use of short splint/plaster for reducible and stable fractures. 5 - 7 …”

Section: Discussionmentioning

confidence: 99%

Radiographic Evaluation of Conservative Treatment of Distal Radius Fractures

Cangussu,

Baldanza,

Carmo

et al. 2024

Acta ortop. bras.

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Objective: This article aims to evaluate the evolution of radio-graphic parameters (radial tilt, volar tilt, and radial height) of distal radius fractures in patients indicated for conservative treatment at three different times: date of diagnosis, first outpatient visit within 2 weeks after closed reduction, and last outpatient visit. Methods: We included 84 patients seen at the emergency department of Hospital Municipal Odilon Behrens, with a diagnosis of distal radius fracture and an indication for conservative treatment. We considered only those patients who had serial radiographs taken at least three different times (n=69) in this analysis. Results: There was an improvement in radiographic parameters of volar tilt after closed reduction and immobilization, which was maintained until the last outpatient visit. Radial inclination and radial height showed increased values from the first to the second radiographic evaluation and both values had regression when comparing the second to the third (last) evaluation. Conclusion: Universal classification stable fractures tend to evolve well with conservative therapy. Level of Evidence II; Development of Diagnostic Criteria in Consecutive Patients (with Gold Standard of Reference Applied).

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“…However, although this was not a randomized study, it was observed a tendency of the use of short splint/plaster for reducible and stable fractures. 5 - 7 …”

Section: Discussionmentioning

confidence: 99%

Radiographic Evaluation of Conservative Treatment of Distal Radius Fractures

Cangussu,

Baldanza,

Carmo

et al. 2024

Acta ortop. bras.

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“…DRFs have a bimodal distribution, with the first peak in the paediatric population and the second peak in the elderly population, in the latter of whom DRFs represent 18% of all fractures [ 2 ]. DRF treatment aims to restore function and minimise complications such as loss of reduction, nerve injury, and pain [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Is Capitate Shift Reliable as a Single Indicator for Failure of Non-operative Management in Distal Radius Fractures?

Donnelly,

Flogaitis,

Lekhi

et al. 2023

Cureus

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Background Distal radius fractures (DRFs) are the most commonly treated fracture; however, their treatment remains controversial. There is significant variation in the rate of surgical intervention related to a lack of consensus regarding the displacement threshold for surgery. Although studies have advocated that carpal malalignment is the most important radiographic parameter for surgical correction, it is rarely considered in general clinical practice and remains poorly studied. Recently, capitate shift was identified as the most useful measure of carpal malalignment, and a capitate shift threshold of -5.98 mm was proposed to indicate surgical intervention. This study aimed to investigate if this threshold is associated with the failure of non-operatively managed DRFs and should be used as a threshold for primary surgical intervention. Methodology A retrospective analysis was performed of all adult patients who underwent closed manipulation and cast immobilisation for DRFs in a UK district general hospital between September 2021 and February 2022. Capitate shift was measured on initial post-casting radiographs using the validated capitate-to-axis-of-radius distance (CARD) by a junior surgeon. The outcome measure was the failure of conservative management, which was defined as the need for repeat intervention (i.e., cast reapplication or surgical fixation) following closed reduction and cast immobilisation. Results A total of 64 patients with 65 DRFs (16 (25%) male, 49 (75%) female) were included in the study. The mean age was 66.6 years (SD = 17.9, 95% CI = 62.2 to 70.9). The mean capitate shift was -1.51 mm (SD = 5.05, 95% CI = -0.28 to -2.73) in all cases (n = 65). The failure rate of DRFs with an ‘unacceptable’ capitate shift (i.e., equal or less than -5.98 mm) compared to those with an ‘acceptable’ capitate shift (i.e., greater than -5.98 mm) was 16.7% versus 3.8% (p = 0.09). Conclusions The study concluded that there was no significant association between a capitate shift threshold of -5.98 mm and failure of non-operatively managed DRFs. Given the ease of use and reliability of capitate shift, we advocate for multicentre large cohort studies to identify a threshold for surgical intervention and establish its association with functional outcomes.

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Short arm splints for wrist stabilization: A mechanical material test and cadaveric radiography study

Rasmussen,

Bang,

Lilleøre

et al. 2024

J. exp. orthop.

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PurposeDocumentation of the wrist stabilizing effect and mechanical properties of common splinting materials is warranted to support evidence‐based condition‐specific recommendations for wrist immobilization. The objectives of this study were to assess the wrist stabilizing properties of volar and dorsal short‐arm splints made of four different materials and evaluate the mechanical properties of the splinting materials.MethodsDorsal and volar short arm splints made of plaster of Paris (PoP) (eight layers), Woodcast (2 mm, rigid vented), X‐lite (classic, two layers) or a 3D‐printed material (polypropylene) were sequentially mounted on 10 cadaveric arm specimens and fixed in a radiolucent fixture. This enabled the evaluation of maximum wrist flexion and extension relative under an orthogonal load of 42 N via radiographic images. In addition, a three‐point bending test was performed on ten sheet duplicates of each of the four splinting materials.ResultsWhen applied as a volar splint, PoP had the highest capability to resist wrist flexion and extension. However, when applied as a dorsal splint, Woodcast exhibited a lower wrist flexion and a similar wrist extension. The 3D‐printed splints—both volar and dorsal—showed the highest mean wrist flexion and extension. The mechanical properties of the Woodcast, X‐lite and 3D‐printed splinting materials were very similar. PoP exhibited distinct properties with a stiffness of 146 (95% confidence interval [CI]: 120–173) N/mm and a deflection at Fmax of 0.6 (95% CI: 0.5–0.7) mm compared to ≤7.7 (95% CI: 7.4–7.9) N/mm and ≥20 (95% CI: 18–22) mm for the other materials.ConclusionPoP displayed better wrist stabilizing properties and material stiffness than Woodcast, X‐lite and 3D‐printed polypropylene. When considering wrist stabilizing properties, PoP may still prove to be the preferred choice for wrist immobilization.Level of EvidenceNot applicable.

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The Effect Immobilization Mechanisms Have on Radiographic Outcomes and Complication Rates in the Conservative Treatment of Distal Radius Fractures: A Systematic Review

Cited by 6 publications

References 37 publications

Radiographic Evaluation of Conservative Treatment of Distal Radius Fractures

Radiographic Evaluation of Conservative Treatment of Distal Radius Fractures

Is Capitate Shift Reliable as a Single Indicator for Failure of Non-operative Management in Distal Radius Fractures?

Short arm splints for wrist stabilization: A mechanical material test and cadaveric radiography study

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