Which immobilization is better for distal radius fracture? A prospective randomized trial.

Abstract

The aim of this study was to determine whether an above-elbow cast (AEC) is better than a below-elbow cast (BEC) at maintaining the initial reduction in the orthopaedic management of a distal radius fracture (DRF). It is a prospective randomized study carried out in a single emergency trauma department. There were 72 patients older than 55years of age (55-96) with a distal radius fracture treated orthopaedically. They were randomized into two groups: group B (AEC 32 patients) and group A (BEC 40 patients). Randomization was done by a computer program. Four subgroups were constituted according to the instability criteria: subgroup 4 the most instable fractures. Main outcome was reduction loss from initial reduction to cast removal: it was measured using the volar tilt, radial tilt and radial length on plain radiographs. No differences were observed between group A and B when analysed globally (volar tilt loss p=0.89 radial tilt loss p=0.08 ulnar variance p=0.19). Subgroups analysis revealed less radial tilt reduction loss in group A in patients within subgroup 3 (p=0.02) and 4 (p=0.003). Results are in contrast to what was expected. Limiting prono-supination AEC is supposed to better maintain initial fracture reduction. Effect of pronation and supination as well as distraction of brachioradialis muscle could have been overestimated until now. The above-elbow cast is not better than the below-elbow cast in terms of loss reduction. However, the below-elbow cast more efficiently controls radial tilt reduction.