International Orthopaedics

, Volume 43, Issue 10, pp 2391–2397 | Cite as

Below- vs above-elbow cast for distal radius fractures: is elbow immobilization really effective for reduction maintenance?

  • Tommaso Maluta
  • Giovanni DibEmail author
  • Matteo Cengarle
  • Alice Bernasconi
  • Elena Samaila
  • Bruno Magnan
Original Paper



The choice of the cast length in conservative management of distal radius fractures still represents a debated controversy. Historically, the elbow is immobilized to reduce the risk of secondary displacement; however, short-arm casts are currently felt to be equally effective with less complications and better patient comfort. This paper investigates whether immobilization of the elbow is actually effective in reducing the risk of loss of reduction in conservatively manipulated distal radius fractures.


We retrospectively studied 297 consecutive patients with distal radius fractures requiring manipulation and subsequently immobilized with above-elbow cast or below-elbow cast. Maintenance of reduction, radial height, radial inclination, and volar tilt were assessed after the reduction and at 35 days. Appropriate statistical analysis was performed to correct data selection bias and to assess any difference in the effectiveness among the two treatments.


The mean difference of loss of radial height, inclination, and volar tilt between the two groups was 0.8 mm, 0.4°, and 0.9° respectively, being not statistically significant. Average difference in reduction maintenance probability between the two groups stratified with a statistical propensity score was 1.2%.


Above- and below-elbow casts had comparable performance in maintaining reduction of manipulated distal radius fractures.


Above-elbow cast Below-elbow cast Distal radius fractures Conservative management of DRF 


Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopedics and Trauma SurgeryUniversity of VeronaVeronaItaly
  2. 2.MSc Biostatistics, Clinical Research UnitAOUI VeronaVeronaItaly

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