Abstract
PurposeFor 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.MethodsThis 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.ResultsThe 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.ConclusionsThis 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.
Highlights
Distal radius fractures (DRF) are among the most frequent types of fracture of the upper limb [1], the best method of treatment and outcome of these fractures has not yet been fully defined [2,3]
PRWE, radiographical measures and rates of reduction loss were similar between groups
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
Summary
Distal radius fractures (DRF) are among the most frequent types of fracture of the upper limb [1], the best method of treatment and outcome of these fractures has not yet been fully defined [2,3]. Regarding non-surgical treatment, a Cochrane review based on randomized controlled trials has concluded that controversy remains in terms of the type of immobilization to be applied after the initial fracture reduction [4]. A recent overview of systematic reviews about the treatment of DRF in adults demonstrated that only two studies were on conservative treatment and none of them underwent meta-analysis [5]. A major systematic review on the topic was carried out by Handoll et al which justified the absence of meta-analysis due to the low quality and heterogeneity in terms of interventions compared and outcome measurement of the included trials [4]. Other studies found similar results between immobilization methods in maintaining the initial fracture reduction [15,16,17,18,19,20]
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