Arm Cast Research Articles

Central band reconstruction in Essex-Lopresti lesions

Restoration of longitudinal forearm stability by reconstruction of the central band (CB) of the interosseous membrane (IOM) of the forearm. Acute and chronic Essex-Lopresti lesions (EL) with longitudinal forearm instability. Absolute: acute/subacute infection. Relative: severe complex regional pain syndrome (CRPS), bony deformity/bone loss, pronounced osteoarthritis of the elbow and wrist. Ulnar approach with exposure of the ulna approximately 6 cm proximal to the ulnar styloid. Creation of a3.5 mm drill hole from ulnar-distal to radial-proximal. AFiberloop (Fa. Arthrex, Naples, FL, USA) is fixed to one end of the LARS (Ligament Advanced Reconstruction System, Fa. Corin Group, Cirencester, UK) in awhipstitch technique, is shuttled through the drill hole from radial to ulnar and fixed over aBicepsButton (Fa. Arthrex, Naples, FL, USA). Exposure of the radius through amodified Henry approach. A3.5 mm drill hole is made from radial-proximal to ulnar-distal approximately 12 cm proximal to the radial styloid. The graft is shuttled from the ulnar to the radial incision directly on the palmar surface of the IOM and shortened to the required length. Another Fiberloop is used to perform awhipstitch on the free end of the LARS. The final fixation of the CB reconstruction is achieved by shuttling the Fiberloop sutures through the radial drill hole with fixation over aBicepsButton. Short-term immobilization in along arm cast with subsequent early functional treatment. Mediocre to poor clinical results are reported in the literature for the treatment of chronic EL. Future research will tell whether the advanced surgical techniques with CB reconstruction will lead to better clinical outcomes.

Bone-cartilage transfer for osteochondritis dissecans of the humeral capitellum

Treatment of focal cartilage defects of the humeral capitellum with autologous bone-cartilage cylinders to prevent development of arthritis of the elbow joint. High-grade, unstable lesions (> 50% of the capitellum, gradeIII-IV according to Dipaola), including those involving the lateral edge of the capitellum and with adepth of up to 15 mm. Stable lesions and generalized osteochondritis of the capitellum (including Panner's disease), as well as arelative contraindication for lesions > 10 mm, as the largest punch has amaximum diameter of 10 mm. Arthroscopy of the elbow joint, transition to open surgery. First, the size of the cartilage defect in the capitellum is determined. Then, one (or several) osteochondral cylinders (OATS Arthex) are removed, which as far as possible completely encompass the defect zone. Corresponding intact bone-cartilage cylinders are obtained from the ipsilateral proximal lateral femoral condyle, each with a0.3 mm larger diameter via an additive miniarthrotomy. The "healthy" cylinders are then inserted into the defect zone in a"press fit" technique. An upper arm cast in neutral position of the hand for 10-14days, simultaneously beginning physiotherapy (active-assisted movements) and lymphatic drainage. As soon as painless range of motion (ROM) is restored (goal: by week6), isometric training can be started. Resistance training starts from week12. Competitive sports are only recommended after 6(-8) months. The current state of research on the surgical treatment of OCD of the humeral capitellum using autologous osteochondral grafts shows mostly promising results. Arecent meta-analysis of 24studies reports asignificantly higher (p < 0.01) rate of return to sports (94%) compared to fragment fixation (64%) or microfracture and debridement (71%) [41]. However, the increased donor-site morbidity must be taken into account (ca. 7.8%).

Distal radius fractures after 75 years of age: are six-month functional and radiological outcomes better with plate fixation than with conservative treatment?

BackgroundSurgery and non-operative treatment produce similar 1-year functional outcomes in patients older than 65 years. Data are lacking for patients older than 75 years. The main objective of this study was to compare surgical vs. non-operative treatment regarding short-term outcomes in patients older than 75 years. In addition to an overall analysis, sub-group analyses were done in patients with displacement and severe displacement (>20 ° posterior tilt). HypothesisSurgery provides better clinical and radiological outcomes than does non-operative treatment. Patients and methodsPatients older than 75 years at the time of a distal radius fracture were included prospectively over a 2-year period. A follow-up duration of at least 6 months was required. Treatment choices were based on displacement, Charlson’s Co-morbidity Index, and patient autonomy. Surgery consisted in open fixation using an anterior locking plate and non-operative treatment in a short arm cast without reduction. The main assessment was based on clinical criteria: range of motion, strength, visual analogue scale (VAS) scores, the short version of the Disabilities of the Arm, Shoulder, and Hand tool (QuickDASH), the Patient Rated Wrist Evaluation (PRWE), and the 36-Item Short Form Health Survey (SF-36). The secondary assessment criteria were the radiological outcomes and the complications. Results74 patients were included, among whom 24 were treated surgically and 50 non-operatively. At 1.5 months, surgery was associated with significantly better results for flexion, ulnar inclination, and supination, with range increases of at least 7 ° vs. non-operative treatment, and with greater dorsal angle and ulnar variance values (p < 0.05 for all comparisons). At 6 months, pronation and the radio-ulnar index were better with surgery (p < 0.05 for both comparisons). In the patients with displacement or severe displacement, surgery was associated with 10° gains vs. conservative treatment for flexion, ulnar inclination, and supination at 1.5 months (p < 0.05 for all comparisons). DiscussionIn patients older than 75 years, surgery for distal radius fracture was associated with significantly better clinical and radiological outcomes within 6 months. Surgery is recommended for displaced and severely displaced distal radius fractures to expedite the recovery of joint motion ranges. Beyond 6 months, the outcomes are similar. Level of evidenceIII.

Management of Unstable Pediatric Distal Radius Fractures With a 2-Pin External Fixator and a Short Arm Cast: Technique and Case Series

Introduction: Pediatric distal radius fractures that are unacceptably aligned and undergo closed reduction are often redisplaced when immobilized in a cast alone without additional fixation. Percutaneous pinning, plate and screw fixation, and 4-pin wrist joint and physis-spanning external fixation constructs have previously been described to achieve and maintain reduction. Technique and Results: We successfully treated and followed 12 consecutive pediatric patients presenting with malaligned, nonphyseal distal radius fractures that were reduced and held with a 2-pin external fixation construct that did not extend distal to the physis, supplemented by a short arm cast. No complications were encountered in this series of patients. Conclusion: Two-pin external fixation is an alternative solution for completely displaced or markedly angulated pediatric distal radius fractures.

Comparison of the forearm rotation restriction capacities of four upper-extremity immobilization methods: there is no difference between single and double sugar tong splinting

BackgroundThe aim of this study was to compare the effects of four different immobilization methods [single sugar tong splint (SSTS), double sugar tong splint (DSTS), short arm cast (SAC), and long arm cast (LAC)] commonly used for restricting forearm rotation in the upper extremity.MethodsForty healthy volunteers were included in the study. Dominant extremities were used for measurements. Basal pronation and supination of the forearm were measured with a custom-made goniometer, and the total rotation arc was calculated without any immobilization. Next, the measurements were repeated with the SAC, LAC, SSTS and DSTS. Each measurement was compared to the baseline value, and the percentage of rotation restriction was calculated.ResultsThe most superior restriction rates were observed for the LAC (p = 0.00). No statistically significant difference was detected between the SSTS and DSTS in terms of the restriction of supination, pronation or the rotation arc (p values, 1.00, 0.18, and 0.50, respectively). Statistically significant differences were not detected between the SAC and the SSTS in any of the three parameters (p values, 0.25; 1.00; 1.00, respectively). When the SAC and DSTS were compared, while there was no significant difference between the two methods in pronation (p = 0.50), a statistically significant difference was detected in supination (p = 0.01) and in the total rotation arc (p = 0.03).ConclusionThe LAC provides superior results in restricting forearm rotation. The SAC and SSTS had similar effects on forearm rotation. The DSTS, which contains, in addition to the SSTS, a sugar tong portion above the elbow, does not provide additional rotational stability.

The midterm psychological effect of cast removal procedures in children.

This study aimed to compare the course of anxiety change in children who used headphones during cast removal with controls in midterm follow-up. Sixty-six patients who underwent forearm fracture treatment with closed reduction and long arm casting between June 2021 and March 2023 were retrospectively reviewed. Patients were divided into two groups based on the use of headphones (n=27; 21 males, 6 females; mean age: 8.0±1.8 years; range, 6 to 12 years) or not (n=39; 27 males, 12 females; mean age: 8.9±1.8 years; range, 6 to 12 years) during cast removal with an oscillating saw. Primary outcome measures included preprocedure, postprocedure, and six-month anxiety assessments with the State-Trait Anxiety Inventory. There was an acute increase in the mean state anxiety scores after the procedure, which returned to below baseline at the six-month follow-up in the headphone (31.4±8.3, 33.3±8.7, and 25.1±4.1, respectively) and control groups (34.9±11.1, 37.4±9.5, and 27.3±5.3, respectively). The mean trait anxiety scores before the procedure, after the procedure, and at six months remained similar in the headphone (33.6±3.0, 34.6±3.2, and 32.4±2.8; p>0.05) and control groups (34.1±2.7, 33.7±3.0, and 33.7±3.0, p>0.05). This study suggests that the acute anxiety during cast removal did not create anxiety sequelae in the sixth month regardless of headphone use.

An optimization study focused on lattice structured custom arm casts for fractured bones inspiring additive manufacturing

In case of fractures, cracks or damage to bone tissues, it is important to use casts, fixatives and protective equipment. Especially in cases where long-term use of casts is required, soft tissue wounds may occur in the human body due to their moisture and airtight structure. For this reason, the use of casts with custom designs, breathable materials, and high mechanical properties has become widespread in recent years. This study focuses on the design of custom arm casts using advanced additive manufacturing technologies and lightweight materials. By utilizing Voronoi lattice structures and hexagonal surface meshes, optimized designs adaptable to additive manufacturing were obtained from a standard arm cast. All cast geometries were investigated under 196 N and 380 N forces. Then, the impact of a 100 g and 1000 g concrete piece with a speed of 12.5 m/s on the arm cast was investigated. As a result of the analyzes, stress, impact plate velocities, deformation, strain and deformation energy were evaluated. The results showed that the designed arm casts have up to 60% better impact strength compared to conventional arm casts. Based on the findings of this study, the use of custom arm casts with optimized lattice structures designed for additive manufacturing will demonstrate high performance.

Navigating Isolated Post-Traumatic Radial Head Dislocation in Adolescents: A Case Report from Bangladesh Emphasizing Management Strategies

Background: Isolated anterior dislocation of the radial head is a rare orthopedic injury, oftenpresenting with distinct clinical features and requiring specialized management. We report the case of an 18-year-old female who presented to our hospital 5 months post-injury, complaining of restricted left elbow joint movement and pain following a fall from a low chair at home. Clinical examination revealed tenderness and anterior dislocation of the radial head, confirmed by radiographs showing isolated anterior dislocation without associated fractures. Closed reduction attempts failed, leading to an open reduction of radial head in combination with correction of malignant with ulnar osteotomy and reconstruction of annular ligament and radio-ulnar Kirschner wire placement for stabilization. An upper arm cast was applied with the forearm in neutral rotation for six weeks. At the 12-month follow-up, the patient exhibited a satisfactory range of motion within reference values, comprising 0-140 degrees of flexion-extension arc, 70 degrees of pronation, and 85 degrees of supination. This range aligned with standards set by the American Society for Surgery of the Hand. The patient reported no impediments in daily activities and returned to her pre-injury level of sports activity based on the Tegner scale. This case underscores the complexity of managing isolated anterior radial head dislocation, highlighting the significance of prompt diagnosis, appropriate reduction techniques, and meticulous postoperative care to achieve optimal functional outcomes. Central Medical College Journal Vol 7 No 1 January 2023 Page: 57-62

Complete Title: Effectiveness of the modified Lafontaine Criteria in Predicting Loss of Reduction In Distal Radius Fracture Running Title: Effectiveness of Lafontaine Criteria in Distal Radius Fractures

Objective: This study aimed to retrospectively test the ability of the modified Lafontaine criteria to predict loss of reduction in distal radius fractures treated conservatively. Materials and methods: Between January 2019 and July 2021, a total of 171 patients aged 50-60 years diagnosed with distal radius fractures and treated with closed reduction and short arm casting were evaluated radiologically. Patients were categorized into two groups based on the modified Lafontaine criteria: Group 1 included patients meeting fewer than three criteria, while Group 2 included those meeting three or more criteria. Parameters such as age, gender, fracture side, fracture type (according to AO classification), follow-up period, radial length, and volar tilt degree after initial reduction were compared with their respective values at the last follow-up. Additionally, changes between values obtained at the last follow-up and those after initial reduction were analyzed. Results: According to the modified Lafontaine criteria, 68 patients were classified into Group 1 and 103 patients into Group 2. Both groups exhibited similar distributions in terms of age, fracture side, and follow-up period (p&gt;0.05). However, Group 2 showed a significantly higher proportion of females compared to Group 1 (p=0.004). Furthermore, Group 2 differed significantly from Group 1 in terms of fracture distribution (p=0.024). Radial lengths and volar tilt degrees after initial reduction showed no significant differences between the groups (p&gt;0.05). At the last follow-up, it was observed that changes in radial length, volar tilt degree, and reduction loss were significantly greater in Group 2 (p&lt;0.05). Analysis of differences between values at the last follow-up and after initial reduction indicated that radial length and volar tilt decreased or changed significantly more in Group 2 (p&lt;0.05). Conclusion: The modified Lafontaine criteria significantly predict higher reduction losses when three or more criteria are present. This study demonstrates that using three criteria as a cut-off can forecast average reduction loss. However, further research is necessary to delve into the individual effects of Lafontaine criteria, their combinations, and their clinical implications.

Efficacy of DIY Cast Covers: An In Vivo Study.

Casting is routinely used in orthopaedics. Preventing a wet cast is crucial for maintaining structural integrity and reducing unwanted complications like unnecessary skin irritation/ulceration, bacterial overgrowth, and unnecessary emergency department visits. Using experimental models, studies have tested various contemporary methods to prevent a wet cast. One such study found that in comparison the most effective and cost-conscious approach was to use a Do-It-Yourself cast cover using a double-bag technique sealed with tape. There is a paucity of literature on the utility of this technique in vivo. The purpose of this study was to investigate the efficacy of the Do-It-Yourself cast cover on human test subjects. Ten volunteers for the study were obtained. Each received one short arm cast and one short leg cast. Each cast was removed after they were deemed dry. These casts were subsequently weighed until they achieved a stable weight. Each cast was then reapplied to the subject's arm and held together with Scotch tape. A trash bag was then applied around the cast and then secured with Duct tape to the skin. This was repeated to create a double seal. These covered, reapplied casts were submerged under water for 2 minutes. After submersion, the cover was removed, and the cast was reweighed. The casts were then submerged completely without any protection for 2 minutes and their fully saturated weight was recorded. Efficacy was determined by comparing the postsubmersion and full-submersion weights. Data was analyzed using the Mann-Whitney test. The percentage of water absorption prevention ranged from 96.8% to 99.9%, with an average of 99.6% across the entire study sample ( P <0.0001). No adverse effects were reported. Our findings conclude that the double-bag with Duct-tape method is effective at preventing external water absorption. This in vivo study demonstrates that almost all external water absorption can be prevented using this simple and inexpensive technique. Level II, prospective comparative study.

Coated Cast Saw Blades Decrease Blade Temperature During Cast Removal.

Thermal injuries can occur during cast removal with an oscillating saw. The purpose of this study is to describe the effect of blade material, blade wear, and cast material on blade temperature. Short arm plaster and fiberglass casts were cured overnight and bivalved with either new or worn stainless-steel or tungsten-disulfide coated blades. Blade use was defined as removing 1 short arm cast. Blades used to remove more than 20 casts were defined as worn. Ten trials were performed with each combination of blade material, blade wear, and cast material, except for the combination of fiberglass and a worn stainless-steel blade due to complete erosion of cutting teeth. Thirty casts were removed with stainless-steel blades, and 40 casts were removed with coated blades. Blade temperature was measured continuously at 5Hz using a T-type thermocouple and microcontroller board. A Mann-Whitney U test was used to compare the mean maximum temperature between groups. For plaster casts, new and worn stainless-steel blades produced mean maximum temperatures of 51.4°C and 63.7°C (P=0.003), respectively. New stainless-steel blades produced significantly higher mean maximum temperatures on fiberglass casts than plaster casts (95.9°C vs. 51.4°C, P<.001). For plaster casts, new and worn coated blades produced mean maximum temperatures of 56.9°C and 53.8°C (P=0.347). For fiberglass casts, new and worn coated blades produced mean maximum temperatures of 76.6°C and 77.7°C (P=0.653). As with new stainless-steel blades, new coated blades produced significantly higher mean maximum temperatures on fiberglass than plaster (76.6°C vs. 56.9°C, P<0.001). Mean maximum temperatures between new stainless-steel and coated blades during removal of plaster casts were 51.4°C and 56.9°C (P=0.131), respectively. However, new coated blades demonstrated significantly lower mean maximum temperatures during fiberglass cast removal compared to new stainless-steel blades (76.6°C vs. 95.9°C, P=0.016). Coated blades outperformed stainless-steel in nearly all combinations. We recommend limited use of stainless-steel blades to minimize blade temperatures during cast removal. Appropriate selection of blade material and monitoring blade wear minimizes blade temperature during cast removal.

Influence of ulnar styloid fracture with concurrent extra-articulardistal radius fracture on forearm rotations

Introduction: This study was conducted to evaluate the relation between extra articular distal radius fracture associated with and without ulnar styloid fracture and the rotational movements of wrist and forearm. Materials and Methods: This retrospective study was performed on 86 unilateral, extra articular distal radius fracture, treated conservatively. Associated ulnar styloid fracture was present in 42 (48.8%) group Aand 44 (51.2%) with intact ulnar styloid group B. Men were 54 (62.8%) and women 32 (37.2%). Distal radius fracture involving right, dominant side were 56 (65.1%). All patients were treated by one surgeon with close reduction under anaesthesia with plaster immobilisation. Long arm cast was applied with forearm in supination wrist in ulnar volar flexion and after 2 weeks changed to below elbow cast with wrist in neutral rotation. Results: The mean limitation of supination was 7.82 ± 5.19 for group 1 (intact styloid) and 23.82±14.41 for group 2 (fractured styloid). The mean limitation of pronation was 4.72 ± 3.68 for group 1 (intact styloid) and 3.29 ± 2.79 for group 2 (fractured styloid). The difference between the two groups was statistically significant regarding the limitation of supination, but not about the 0 0 0 limitation of pronation. The average pronation deformity was 120 (range 60 to 190 ) in patients with dorsal malunion and 110 0 (range 50 to 210) in volar malunion. The supination deformity averaged at about 80° (range 40° to 140°) in dorsal and 120 0 0 (range 80 to 170 ) in volarly angulated distal radius malunion. Conclusion: The association of extra articular distal radius fracture with fracture ulnar styloid at two year follow up causes restriction of supination and pronation of forearm

Flexible Titanium Intramedullary Nail Displacement After Magnetic Resonance Imaging.

A previously healthy 7-year-old boy presented with midshaft radius and ulna malunion after 8 weeks of nonsurgical treatment. He underwent open reduction and internal fixation of both bones with titanium alloy nails and was placed in a long arm cast. Four weeks after surgery, the patient underwent sedated brain MRI and woke up from anesthesia with elbow pain. On cast removal, the ulnar flexible nail was noted to have displaced proximally by 1.5 cm. Despite meeting American Society for Testing and Materials standards, untethered titanium orthopaedic implants are at risk of clinically significant displacement in the early postoperative period.

Modifiable and non-modifiable risk factors for failure of non-operative treatment of pediatric forearm fractures: Where can we do better?

Distal third forearm fractures are common fractures in children. While outcomes are generally excellent, some patients fail initial non-operative management and require intervention. The purpose of this study is to identify independent risk factors associated with failure of closed reduction. We conducted a retrospective review of distal third forearm fractures in children treated with closed reduction and casting. Patients were divided into two cohorts-those who were successfully closed reduced and those who failed initial non-operative management. Demographic characteristics, cast type, cast index, radiographic fracture, soft tissue characteristics, and quality of reduction were analyzed between groups. A total of 207 children treated for distal third forearm fractures were included for analysis. A total of 190 (91.8%) children maintained their reduction while 17 (8.2%) failed initial non-operative management. Modifiable risk factors associated with loss of reduction on univariate analysis included the use of a long arm cast (p = 0.003), increased post-reduction displacement (p = 0.02), and increased post-reduction angular deformity (p = 0.01). Non-modifiable risk factors included increased body mass index (p = 0.02), increased presenting fracture displacement (p = 0.002), and increased width of the soft tissue envelope at the fracture site (p = 0.0001). The use of long arm casts (13% vs 2%, odds ratio = 6.44) and soft tissue width (60.6 vs 50.4 mm, odds ratio = 1.1) remained significant risk factors for loss of reduction after multivariate analysis. Both larger soft tissue envelope at the site of the fracture and long arm cast immobilization are independently associated with an increased risk of failing initial closed reduction in distal third forearm fractures in the pediatric population. level III Case Control Study.

The Slipper Fracture: Revisited.

Objectives The term "slipper fracture" is usedto describe a fracture of the radius at the junction of the metaphysis and diaphysis. This fracture has an "evil" reputation because it often angulates in the cast.Historically, there have been differing opinions on the optimal way to cast slipper fractures either with a long arm cast in pronation or a long arm cast in supination to prevent angulation. The purpose of this study is to report the outcomes of "slipper fractures" treated with casting. Methods Sixteen slipper fractures were retrospectively reviewed. Electronic medical records (EMRs) and radiographs were analyzed to gather data on body weight, cast type, cast position, cast index, loss of reduction, cast wedging, repeat reduction, surgery, and amount of remodeling. Results The average age of the patients was eight years old. The average body weight was 30.4 kg.Initial casting included 14 long arm casts in neutral, one short arm cast, and one sugar tong splint. The average cast index was 0.87. Only one cast had a cast index of less than 0.8. This fracture was treated with a long arm cast and did not displace. Of the fractures,94% lost reduction in the cast and angulated an average of 26 degrees. Two cases were treated with a cast wedge; 13 were observed. Remodeling occurred at an average rate of 2.7 degrees/month. The average remodeling measured at the last follow-up was 15 degrees. Conclusion Slipper fractures are difficult to treat due to the angulation of the fracture in the cast. The current study indicates that a long arm cast,appropriate cast index, and cast position are key to preventing the loss of reduction or angulation of a slipper fracture.

A comparison of two immobilization methods in the conservative treatment of pediatric distal forearm fractures: Long arm cast versus single sugar-tong splint.

The aim of this study was to compare the results of single sugar-tong splint (SSTS) and long arm cast (LAC) as an immobilization method in pediatric distal forearm fractures. Between January 2016 and December 2019, a total of 186 pediatric patients (143 males, 43 females; mean age: 10.3±3 years; range, 4 to 15 years) with distal forearm fractures were retrospectively analyzed. The patients were divided into two groups according to the immobilization method: SSTS group (n=74) and LAC group (n=112). All patients were evaluated at the time of admission, immediately after the reduction, and at one, two, and four weeks. Sagittal and coronal plane angulations and translation percentages of the radius at each visit were calculated. Alterations in coronal angle, sagittal angle, sagittal translation and coronal translation were calculated by subtracting the measurements after reduction from the measurements at four weeks. Both groups were comparable in terms of demographic characteristics, fracture localization, and side of injured extremity. There was a statistically significant difference only in the sagittal angulations in the first (LAC: 4.7; SSTS: 6.5; p=0.009) and second week (LAC: 5.3; SSTS: 6.8; p=0.024). The rest of radiological measurements were comparable. In the LAC group, seven patients had re-intervention (three manipulations, four surgeries) and in the SSTS group, three patients had re-intervention (two manipulations, one surgery) (p=0.657). Our study results suggest that SSTS and LAC are comparable in terms of radiological results and need for re-intervention as an immobilization method of pediatric distal forearm fractures.

Smartphone-based Data Acquisition Method for Modelling 3D Printed Arm Casts

In recent years, 3D printed arm casts can replace traditional arm casts to treat bones fractures. 3D printed arm cast modelling often uses professional 3D scanning systems to capture 3D data of the arm. These systems are very expensive and may not be available in many hospitals. In order to over-come this disadvantage, inexpensive methods should be developed. This paper introduces a new data collection method based on smartphones. The photos of an arm were taken with a smartphone cam-era using some special techniques that could facilitate the process of image processing and 3D mod-elling in Agisoft Metashape and CATIA. To validate the proposed method, the photogrammetric model was compared with the scanned model (obtained by a low cost scanner) in GOM Inspect. Be-sides, a fit check of real 3D printed arm casts attached on the volunteer's forearm was also per-formed. The test results indicate that the photogrammetric model could be used as raw data for 3D arm modelling.

Differences in Inflammation, Radiological and Clinical Outcomes between Short Arm Cast and Long Arm Cast in Intraarticular Distal Radius Fractures

BACKGROUND: Distal radius fractures are the most common upper extremity fractures with a prevalence of 20% of all limb fractures. According to the distal radius fracture guidelines by the American Academy of orthopedic surgeons, conservative therapy can be used in the management of distal radius fractures that are well reduced. AIM: The purpose of this study was to compare conservative therapy of short arm cast (SAC) and long arm cast (LAC) in the management of intraarticular distal radius fractures. METHODS: A prospective cohort observational study with consecutive sampling was conducted on 24 intraarticular distal fracture patients who underwent SAC and LAC procedures. The parameters measured were Interleukin-6 (IL-6) score, ulnar variance (UV), dorsal tilt (DT), articular step-off (SO), radiological union score system (RUSS), and patient-rated wrist evaluation (PRWE) score. RESULTS: The dominance of patients was males aged 46 years, with an average IL-6 levels at 0–24 was 1139.23 ± 266.82 SAC and 1082.64 ± 255.85 LAC, and IL-6 levels at 48 h was 102.98 ± 39.31 SAC and 118.38 ± 39.15 LAC; 2 patients with SAC and 1 patient with LAC obtained unacceptable reduction at week 2 based on UV, DT, SO which did not differ significantly from each follow-up; RUSS 6.08 ± 0.76 SAC and 5.71 ± 0.61 LAC; and PRWE 73.23 ± 4.42 SAC and 71.86 ± 4.07 LAC. Based on statistical analysis, there were insignificant differences in IL-6, UV, DT, SO, RUSS, and PRWE levels between the SAC and LAC groups (p &gt; 0.05). CONCLUSION: Conservative therapy with SAC may be an option for immobilization of distal radius fracture similar to LAC.

COMPLICATIONS ASSOCIATED WITH CASTING OF ACUTE DISTAL RADIUS FRACTURES IN ADULTS - A PROSPECTIVE OBSERVATIONAL STUDY

Aim: Closed treatment of distal radius fractures is still a controversy. In children, circumferential casting of acute distal radius fractures is found to be safe. However, research is lacking to demonstrate its safety in adults. The purpose of this study was to assess the risk of complications associated with casting acute distal radius fractures in adult patients. Methods: Study is conducted in 60 patients with a distal radius fracture arriving at the Emergency department in Govt Theni Medical College. Patients were evaluated in the red zone and were provisionally immobilized with plaster of Paris casts. Patients were followed for a minimum of 12 weeks. Complication rates associated with casting were recorded, including rates of fracture displacement, tenosynovitis, carpal tunnel syndrome and malunion. Results: 60 patients were included in this study. A total of 45 patients met inclusion criteria for placement of a short arm cast in the Emergency Department. The majority of patients sustained their injuries from a ground level fall. A minority of patients had radiographic evidence of intra-articular extension or underwent a reduction prior to casting. The majority of patients did not require a cast change. The data analysis showed the complications such as fracture displacement, tenosynovitis, carpal tunnel syndrome malunion were of insignificant value and closed reduction proved to the safest and benefitted method of management in distal radius fractures with lesser complications. Conclusion: There were no major complications associated with casting of acute, distal radius fractures in this series of 45 adult patients. While further studies with larger numbers of patients are necessary to establish safety of casting, this study suggests that casting may be a safe and effective treatment for distal radius fractures in adult patients presenting with a normal neurovascular exam.

Trauma-Related Clinical Practice Variation in Dutch Emergency Departments.

Structural insights in the use of protocols and the extent of practice variation in EDs are lacking. The objective is to determine the extent of practice variation in EDs in The Netherlands, based on specified common practices. We performed a comparative study on Dutch EDs that employed emergency physicians to determine practice variation. Data on practices were collected via a questionnaire. Fifty-two EDs across The Netherlands were included. Thrombosis prophylaxis was prescribed for below-knee plaster immobilization in 27% of EDs. Vitamin C was prescribed in 50% of EDs after a wrist fracture. Splitting of applied casts to the upper or lower limb was performed in one-third of the EDs. Analysis of the cervical spine after trauma was performed by the NEXUS criteria (69%), the Canadian C-spine Rule (17%) or otherwise. The imaging modality for cervical spine trauma in adults was a CT scan (98%). The cast used for scaphoid fractures was divided between the short arm cast (46%) and the navicular cast (54%). Locoregional anaesthesia for femoral fractures was applied in 54% of the EDs. EDs in The Netherlands showed considerable practice variation in treatments among the subjects studied. Further research is warranted to gain a full understanding of the variation in practice in EDs and the potential to improve quality and efficiency.