Abstract
Introduction
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).
Methods
It is a prospective randomized study carried out in a single emergency trauma department. There were 72 patients older than 55 years 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.
Results
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).
Discussion
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.
Conclusion
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.
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Therapeutic level I.
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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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On behalf of all authors, the corresponding author states that there is no conflict of interest.
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Gamba, C., Fernandez, F.A.M., Llavall, M.C. et al. Which immobilization is better for distal radius fracture? A prospective randomized trial. International Orthopaedics (SICOT) 41, 1723–1727 (2017). https://doi.org/10.1007/s00264-017-3518-y
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DOI: https://doi.org/10.1007/s00264-017-3518-y