Comparison of volar-flexion, ulnar-deviation and functional position cast immobilization in the non-operative treatment of distal radius fracture in elderly patients: a pragmatic randomized controlled trial study protocol

Lauri Raittio,Aleksi Reito,Minna Laitinen,Ville M Mattila,Bakir Sumrein,Toni Luokkala,Teemu Hevonkorpi,Juha Kukkonen,Antti Launonen

doi:10.1186/s12891-017-1759-y

Abstract

BackgroundDistal radius fractures (DRFs) are the second most common fractures, after hip fractures, seen in clinical practice. The high incidence of low-energy trauma DRFs in elderly patients raises questions about the best treatment method in terms of function, pain, and quality of life. Although the majority of these fractures are treated non-operatively with cast immobilization, valid scientific evidence of the optimal cast immobilization is lacking. In addition, several publications, including Cochrane review have outlined the need for more evidence to determine the most appropriate method of cast immobilization.MethodsThis study is a pragmatic, prospective, randomized, multi-centre trial. The trial is designed to compare two widely used cast positions (volar flexion-ulnar deviation position and functional position) for the non-operative treatment of DRF in patients over 64 years of age. The main hypothesis of the trial is that function position yields corresponding functional outcome, pain relief and quality of life when compared to the volar flexion-ulnar deviation position. The primary outcome measure is Patient Rated Wrist Evaluation (PRWE) score and the secondary outcome measures will be the Disabilities of the Arm, Shoulder and Hand (DASH) score, Visual Analogue Scale (VAS), 15-dimensional (15D) value and rate of surgical interventions. The results of the trial will be analysed after 1 and 2-years.DiscussionThis publication presents a prospective, pragmatic, randomized, national multi-centre trial study protocol. It provides details of patient flow, randomization, follow-up and methods of analysis of the material as well as publication plan.Trial registrationClinicalTrials.gov identifier: NCT02894983 22 August 2016.

Highlights

Distal radius fractures (DRFs) are the second most common fractures, after hip fractures, seen in clinical practice
Evaluation of treatment Treatment outcomes of DRFs can be measured with a variety of tools
The tools used in the evaluation measure the mobility and usability of the forearm and wrist and include the Patient Rated Wrist Evaluation (PRWE) questionnaire, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Gartland-Werley questionnaire and the Visual Analogue Scale (VAS)

Summary

Introduction

Distal radius fractures (DRFs) are the second most common fractures, after hip fractures, seen in clinical practice. The high incidence of low-energy trauma DRFs in elderly patients raises questions about the best treatment method in terms of function, pain, and quality of life. Distal radius fractures (DRFs) are prevalent in the general population, and in patients over 60 years of age they are the second most common fractures after hip fractures. A significant proportion of fractures will lose alignment during cast immobilization, >especially in older patients with osteoporotic bone. The alignment of these unstable fractures is often acceptable after closed reduction and at the beginning of cast immobilization, but is lost during the period the cast is worn [9]

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