Skip to main content
SpringerLink
Log in

Distal radial fractures in adults: 4 versus 6 weeks of cast immobilisation after closed reduction, a randomised controlled trial

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

In this study, we aim to evaluate whether the functional outcome of Distal Radius Fractures (DRFs) could be enhanced by shortening the period of immobilisation from six weeks to four weeks.

Methods

This study is a single blinded randomised controlled trial. Four week plaster cast immobilisation was compared with six week plaster cast immobilisation in adult patients (older than 18 years) with adequately reduced DRFs. The primary outcome parameters were functional outcome measured by Quick DASH score after 1-year follow-up. Secondary outcomes were: Quick DASH after three months, 6 months, range of motion, and complications (such as number of re-interventions, secondary displacement, delayed and non-union).

Results

80 patients (16 male and 64 female, mean age, 61.76 years) were included and randomized. 65 patients completed the 1-year follow-up. After 1-year follow up, no significant differences were found between the two groups in the QUICK DASH score (P = 0.55). Moreover, no significant differences in DASH Score after three and six months (P = 0.24, 0.28, respectively). The complication rate among both cohorts was almost similar, (P = 0.51).

Conclusion

Reduction in the time of cast immobilisation in patients with DRFs in accepted position reported similar outcomes. Of note, the complication rate in the four and six weeks was also the same. Thus, 4 weeks in cast is a safe immobilisation period.

Clinical Trials Number Trial registration number and date of registration for prospectively registered trials at http://ClinicalTrials.gov (NCT05012345), on 19/08/2021.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Rundgren J, Bojan A, Mellstrand Navarro C, Enocson A (2020) Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register. BMC Musculoskelet Disord 21:88. https://doi.org/10.1186/s12891-020-3097-8

    Article  PubMed  PubMed Central  Google Scholar 

  2. Jerrhag D, Englund M, Karlsson MK, Rosengren BE (2017) Epidemiology and time trends of distal forearm fractures in adults—a study of 11.2 million person-years in Sweden. BMC Musculoskelet Disord 18:240. https://doi.org/10.1186/s12891-017-1596-z

    Article  PubMed  PubMed Central  Google Scholar 

  3. de Putter CE, Selles RW, Polinder S et al (2012) Economic impact of hand and wrist injuries: health-care costs and productivity costs in a population-based study. J Bone Jt Surg 94:e56. https://doi.org/10.2106/JBJS.K.00561

    Article  Google Scholar 

  4. Beumer A, McQueen MM (2003) Fractures of the distal radius in low-demand elderly patients: closed reduction of no value in 53 of 60 wrists. Acta Orthop Scand 74:98–100. https://doi.org/10.1080/00016470310013743

    Article  PubMed  Google Scholar 

  5. Howell M, Lawson A, Naylor J et al (2022) Surgical plating versus closed reduction for fractures in the distal radius in older patients: a cost-effectiveness analysis from the hospital perspective. ANZ J Surg. https://doi.org/10.1111/ans.18134

    Article  PubMed  Google Scholar 

  6. Christensen OM, Christiansen TG, Krasheninnikoff M et al (1995) Length of immobilisation after fractures of the distal radius. Int Orthop 19:552. https://doi.org/10.1007/BF00184910

    Article  Google Scholar 

  7. Hansen FV, Staunstrup H, Mikkelsen S (1998) A comparison of 3 and 5 weeks immobilization for older type 1 and 2 Colles’ fractures. J Hand Surg Am 23:400–401. https://doi.org/10.1016/S0266-7681(98)80067-3

    Article  Google Scholar 

  8. Abbaszadegan H, von Sivers K, Jonsson U (1988) Late displacement of Colles’ fractures. Int Orthop 12:197–199. https://doi.org/10.1007/BF00547163

    Article  CAS  PubMed  Google Scholar 

  9. Solgaard S (1986) Early displacement of distal radius fracture. Acta Orthop Scand 57:229–231. https://doi.org/10.3109/17453678608994383

    Article  CAS  PubMed  Google Scholar 

  10. Solgaard S (1988) Function after distal radius fracture. Acta Orthop Scand 59:39–42. https://doi.org/10.3109/17453678809149341

    Article  CAS  PubMed  Google Scholar 

  11. McAuliffe T, Hilliar K, Coates C, Grange W (1987) Early mobilisation of Colles’ fractures. A prospective trial. J Bone Joint Surg Br 69-B:727–729. https://doi.org/10.1302/0301-620X.69B5.3316238

    Article  Google Scholar 

  12. Calvert M, Blazeby J, Altman DG et al (2013) Reporting of patient-reported outcomes in randomized trials. JAMA 309:814. https://doi.org/10.1001/jama.2013.879

    Article  CAS  PubMed  Google Scholar 

  13. Kamal RN, Shapiro LM (2023) Practical application of the 2020 distal radius fracture AAOS/ASSH clinical practice guideline: a clinical case. J Am Acad Orthop Surg. https://doi.org/10.5435/JAAOS-D-21-01194

    Article  PubMed  Google Scholar 

  14. Handoll HH, Madhok R (2003) Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD000314

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bruder AM, Shields N, Dodd KJ et al (2016) A progressive exercise and structured advice program does not improve activity more than structured advice alone following a distal radial fracture: a multi-centre, randomised trial. J Physiother 62:145–152. https://doi.org/10.1016/j.jphys.2016.05.011

    Article  PubMed  Google Scholar 

  16. MD WBGMJDH (1994) Clinical measurement of joint motion, 1st Edn. American Academy of Orthopaedic Surgeons

  17. Gummesson C, Atroshi I, Ekdahl C (2003) The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord 4:11. https://doi.org/10.1186/1471-2474-4-11

    Article  PubMed  PubMed Central  Google Scholar 

  18. Pan W (2001) Akaike’s information criterion in generalized estimating equations. Biometrics 57:120–125. https://doi.org/10.1111/j.0006-341X.2001.00120.x

    Article  CAS  PubMed  Google Scholar 

  19. Harden RN, Oaklander AL, Burton AW et al (2013) Complex regional pain syndrome: practical diagnostic and treatment guidelines. Pain Med 14:180–229. https://doi.org/10.1111/pme.12033

    Article  PubMed  Google Scholar 

  20. Bentohami A, van Delft E, Vermeulen J et al (2019) Non- or minimally displaced distal radial fractures in adult patients: three weeks versus five weeks of cast immobilization—A randomized controlled trial. J Wrist Surg 08:043–048. https://doi.org/10.1055/s-0038-1668155

    Article  CAS  Google Scholar 

  21. Changulani M, Okonkwo U, Keswani T, Kalairajah Y (2008) Outcome evaluation measures for wrist and hand—which one to choose? Int Orthop 32:1–6. https://doi.org/10.1007/s00264-007-0368-z

    Article  PubMed  Google Scholar 

  22. Millet PJ, Rushton N (1995) Early mobilization in the treatment of Colles’ fracture: a 3 year prospective study. Injury 26:671–675. https://doi.org/10.1016/0020-1383(95)00146-8

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma and Orthopaedic, Cork University Hospital, Cork, Ireland

    Hany Elbardesy, Muhammad Irfan Yousaf, David Reidy, Muhammad Ilyas Ansari & James Harty

Authors
  1. Hany Elbardesy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Muhammad Irfan Yousaf
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Reidy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Muhammad Ilyas Ansari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. James Harty
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hany Elbardesy.

Ethics declarations

Conflict of interest

The authors did not receive support from any organization for the submitted work. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elbardesy, H., Yousaf, M.I., Reidy, D. et al. Distal radial fractures in adults: 4 versus 6 weeks of cast immobilisation after closed reduction, a randomised controlled trial. Eur J Orthop Surg Traumatol 33, 3469–3474 (2023). https://doi.org/10.1007/s00590-023-03574-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-023-03574-2

Keywords

Search

Navigation