Abstract
BOAST (British Orthopaedic Association Standards for Trauma & Orthopaedics) guidelines recommended that during the coronavirus pandemic most upper limb fractures should be treated conservatively, and removable casts should be used, where possible. As a result, our district general hospital started using a new soft combination (soft-combi) casting technique for conservative management of distal radius fractures (DRFs) in an attempt to reduce follow-up attendances.To assess if radiological outcomes of soft-combi casts are better or worse than previously used rigid casts for DRFs.Twenty DRFs treated with soft-combi casts were compared with 20 DRFs treated with the old rigid cast types. Radiological parameters were measured pre-manipulation, post-manipulation, at 2-week follow-up, and at final follow-up. Statistical analysis was performed to assess for significant differences seen at follow-up between the groups.The mean loss of volar angulation seen at 2-week follow-up was 4.9° for the rigid casts vs. 1.5° for the soft-combi casts (p = 0.158; 95% CI, − 8.17 to 1.38). The mean loss of radial height after 2 weeks was 0.2 mm vs 0.5 mm (p = 0.675; 95% CI, − 1.09 to 1.66), and the mean loss of radial inclination was 2.0° vs 1.0° (p = 0.349; 95% CI, − 2.96 to 1.07), respectively.The soft-combi casts appeared to be equally effective at maintaining the reduction of DRFs compared to their rigid counterparts, as no statistically significant difference was seen in our study. We can be reassured that continued use of these removable casts in the current climate is unlikely to have a detrimental effect on outcomes for DRFs.
Highlights
Distal radius fractures (DRFs) are a common low-energy injury, often seen in those with osteoporosis following a fall on an outstretched hand
The number of DRFs occurring in indoor spaces remains constant throughout the year, and as such, it has remained a common presentation to hospital throughout the pandemic, despite the restrictions on outdoor activities put in place [2]
On in the coronavirus pandemic, the British Orthopaedic Association (BOA) released guidelines suggesting that most upper limb fractures could be treated non-operatively, whilst recognising that some patients may need reconstruction further down the line as a result
Summary
Distal radius fractures (DRFs) are a common low-energy injury, often seen in those with osteoporosis following a fall on an outstretched hand. Whilst we have seen a reduction in trauma cases during the coronavirus (COVID-19) pandemic, low-energy fragility fractures have continued to make up a sizeable proportion of orthopaedic cases [1]. The use of removable casts or splints was advised in an effort to reduce follow-up requirements [3]. These guidelines were created in order to utilise limited National Health Service resources during a time of unprecedented burden
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