The effect of long- or short-arm casting on the stability of reduction and bone mineral density in conservative treatment of Colles' fractures

Abstract

We evaluated the effect of long- or short-arm casting on the stability of reduction and bone mineral density (BMD) in the forearm in patients treated conservatively for Colles' fractures (CF). Eighty-three patients (48 females, 35 males; mean age 53 years; range 30 to 76 years) with an isolated unilateral CF underwent closed reduction followed by a randomly assigned long-arm (n=44) or short-arm (n=39) casting. Fractures were classified according to the Frykman's system. After reduction, radiographs of both forearms were taken, on which radial height and inclination, and volar tilt were measured and assessed according to the criteria by Sarmiento et al. In the first week, BMD measurements were made on the unaffected side to obtain reference values from four sites of the forearm, namely ultradistal, 1/3 proximal, middle diaphysis, and total. Following removal of the casts (mean 45.3 days; range 40 to 55 days), radiographic and BMD assessments were repeated. Osteoporosis was defined according to the criteria of the World Health Organization. The two casting groups were similar with respect to age, sex, Frykman's classification, involved side, and the dominant extremity. Osteoporosis was detected in 20% according to the T scores. All the sites in the fractured forearm showed density losses, but the difference was significant only in the middle diaphysis (p<0.05). No significant relationship was found between BMD losses and the cast type. Angular measurements showed significant deterioration after union; however, none was found to be related to the cast type (p>0.05). Our results show that BMD losses and deterioration in reduction following treatment of CF occur irrespective of which type of casting is used.