Duration of Cast Immobilization in Distal Radial Fractures: A Systematic ReviewFunding None.
29. Oktober 2018
28. Januar 2019
18. März 2019 (online)
Objective The duration of immobilization in distal radial fractures is disputed in the current literature. There are still no long-term superior outcomes of operative treatment in comparison to nonoperative treatment. A systematic review was initiated to assess the clinical controversy on the duration of the immobilization period for nonoperatively treated distal radial fractures.
Materials and Methods A comprehensive search was performed in the PubMed, Embase, and Wiley/Cochrane Library databases and a manual reference check of the identified systematic reviews and meta-analyses was executed. Eligible studies were randomized controlled trials that compared two periods of immobilization, with reported functional, patient-reported, and radiological outcomes. Two reviewers independently agreed on eligibility, and assessed methodological quality and extracted outcome data.
Results The initial search yielded 3.384 studies. Twelve trials, with 1063 patients, were included in this systematic review. Grip strength and patient-reported outcome were better in patients treated by a shorter period of immobilization. There was no difference in pain, range of motion, or radiological outcome between different periods of immobilization. Owing to heterogeneity of studies, data were unsuitable for pooling.
Conclusion Included studies showed that there might be a preference for a shorter period of immobilization in nonoperatively treated distal radius fractures. Therefore, shortening the period of immobilization in distal radial fractures to a maximum of three weeks should be considered. Future research should include homogeneous groups of patients to draw valid conclusions on the appropriate period of immobilization for nonoperatively treated distal radial fractures.
Level of Evidence This is a Level II study.
Systematic Review Registration Number PROSPERO 2018 CRD42018085524.
Keywordsnonoperative treatment - distal radial fractures - fractures of the upper extremity - immobilization period
The study was performed at Amsterdam UMC, Vrije Universiteit Amsterdam.
- 1 Anzarut A, Johnson JA, Rowe BH, Lambert RG, Blitz S, Majumdar SR. Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures. J Hand Surg Am 2004; 29 (06) 1121-1127
- 2 Beumer A, McQueen MM. Fractures of the distal radius in low-demand elderly patients: closed reduction of no value in 53 of 60 wrists. Acta Orthop Scand 2003; 74 (01) 98-100
- 3 Einsiedel T, Becker C, Stengel D. , et al. Frakturen der oberen Extremität beim geriatrischen Patienten - Harmlose Monoverletzung oder Ende der Selbstständigkeit? Eine prospektive Studie zum Outcome nach distaler Radius- und proximaler Humerusfraktur bei über 65-jährigen [Do injuries of the upper extremity in geriatric patients end up in helplessness? A prospective study for the outcome of distal radius and proximal humerus fractures in individuals over 65]. Z Gerontol Geriatr 2006; 39 (06) 451-461
- 4 Goldfarb CA, Yin Y, Gilula LA, Fisher AJ, Boyer MI. Wrist fractures: what the clinician wants to know. Radiology 2001; 219 (01) 11-28
- 5 Abbaszadegan H, von Sivers K, Jonsson U. Late displacement of Colles' fractures. Int Orthop 1988; 12 (03) 197-199
- 6 Bentohami A, van Delft EAK, Vermeulen J. , et al. 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 2019; 8 (01) 43-48
- 7 Christensen OM, Christiansen TG, Krasheninnikoff M, Hansen FF. Length of immobilisation after fractures of the distal radius. Int Orthop 1995; 19 (01) 26-29
- 8 Jensen MR, Andersen KH, Jensen CH. Management of undisplaced or minimally displaced Colles' fracture: one or three weeks of immobilization. J Orthop Sci 1997; 2 (06) 424-427
- 9 Vang Hansen F, Staunstrup H, Mikkelsen S. A comparison of 3 and 5 weeks immobilization for older type 1 and 2 Colles' fractures. J Hand Surg [Br] 1998; 23 (03) 400-401
- 10 Solgaard S. Early displacement of distal radius fracture. Acta Orthop Scand 1986; 57 (03) 229-231
- 11 Solgaard S. Function after distal radius fracture. Acta Orthop Scand 1988; 59 (01) 39-42
- 12 Cooney III WP, Dobyns JH, Linscheid RL. Complications of Colles' fractures. J Bone Joint Surg Am 1980; 62 (04) 613-619
- 13 Foster BD, Sivasundaram L, Heckmann N, Pannell WC, Alluri RK, Ghiassi A. Distal radius fractures do not displace following splint or cast removal in the acute, postreduction period: a prospective, observational study. J Wrist Surg 2017; 6 (01) 54-59
- 14 Mann FA, Wilson AJ, Gilula LA. Radiographic evaluation of the wrist: what does the hand surgeon want to know?. Radiology 1992; 184 (01) 15-24
- 15 Mulders MA, Goslings JC, Schep NWL. Behandeling extra-articulaire distale radiusfractuur, de VIPER-studie: chirurgie versus gips. NTVG, 2014
- 16 Diaz-Garcia RJ, Chung KC. Common myths and evidence in the management of distal radius fractures. Hand Clin 2012; 28 (02) 127-133
- 17 Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin 2012; 28 (02) 113-125
- 18 Arora R, Lutz M, Deml C, Krappinger D, Haug L, Gabl M. A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am 2011; 93 (23) 2146-2153
- 19 Bentohami A, de Burlet K, de Korte N, van den Bekerom MP, Goslings JC, Schep NW. Complications following volar locking plate fixation for distal radial fractures: a systematic review. J Hand Surg Eur Vol 2014; 39 (07) 745-754
- 20 Gong HS, Lee JO, Huh JK, Oh JH, Kim SH, Baek GH. Comparison of depressive symptoms during the early recovery period in patients with a distal radius fracture treated by volar plating and cast immobilisation. Injury 2011; 42 (11) 1266-1270
- 21 Ward CM, Kuhl TL, Adams BD. Early complications of volar plating of distal radius fractures and their relationship to surgeon experience. Hand (N Y) 2011; 6 (02) 185-189
- 22 McFadyen I, Field J, McCann P, Ward J, Nicol S, Curwen C. Should unstable extra-articular distal radial fractures be treated with fixed-angle volar-locked plates or percutaneous Kirschner wires? A prospective randomised controlled trial. Injury 2011; 42 (02) 162-166
- 23 Rozental TD, Blazar PE, Franko OI, Chacko AT, Earp BE, Day CS. Functional outcomes for unstable distal radial fractures treated with open reduction and internal fixation or closed reduction and percutaneous fixation. A prospective randomized trial. J Bone Joint Surg Am 2009; 91 (08) 1837-1846
- 24 Einsiedel T, Freund W, Sander S, Trnavac S, Gebhard F, Kramer M. Can the displacement of a conservatively treated distal radius fracture be predicted at the beginning of treatment?. Int Orthop 2009; 33 (03) 795-800
- 25 Handoll HH, Madhok R. Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev 2003; (02) CD000314
- 26 Christersson A, Larsson S, Sandén B. Clinical outcome after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomized study. Scand J Surg 2018; 107 (01) 82-90
- 27 Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 2001; 8 (12) 1153-1157
- 28 Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis 1978; 37 (04) 378-381
- 29 Scott J, Huskisson EC. Vertical or horizontal visual analogue scales. Ann Rheum Dis 1979; 38 (06) 560
- 30 Gummesson C, Ward MM, Atroshi I. The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord 2006; 7 (44) 44
- 31 MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 1998; 12 (08) 577-586
- 32 Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 1987; (214) 136-147
- 33 Gartland Jr JJ, Werley CW. Evaluation of healed Colles' fractures. J Bone Joint Surg Am 1951; 33-A (04) 895-907
- 34 Lidström A. Fractures of the distal end of the radius. A clinical and statistical study of end results. Acta Orthop Scand Suppl 1959; 41 (41) 1-118
- 35 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
- 36 Ferris BD, Thomas NP, Dewar ME, Simpson DA. Brace treatment of Colles' fracture. Acta Orthop Scand 1989; 60 (01) 63-65
- 37 Ledingham WM, Wytch R, Goring CC, Mathieson AB, Wardlaw D. On immediate functional bracing of Colles' fracture. Injury 1991; 22 (03) 197-201
- 38 Moir JS, Murali SR, Ashcroft GP, Wardlaw D, Matheson AB. A new functional brace for the treatment of Colles' fractures. Injury 1995; 26 (09) 587-593
- 39 O'Connor D, Mullett H, Doyle M, Mofidi A, Kutty S, O'Sullivan M. Minimally displaced Colles' fractures: a prospective randomized trial of treatment with a wrist splint or a plaster cast. J Hand Surg [Br] 2003; 28 (01) 50-53
- 40 Tumia N, Wardlaw D, Hallett J, Deutman R, Mattsson SA, Sandén B. Aberdeen Colles' fracture brace as a treatment for Colles' fracture. A multicentre, prospective, randomised, controlled trial. J Bone Joint Surg Br 2003; 85 (01) 78-82
- 41 Pool C. Colles's fracture. A prospective study of treatment. J Bone Joint Surg Br 1973; 55 (03) 540-544
- 42 Abbaszadegan H, Conradi P, Jonsson U. Fixation not needed for undisplaced Colles' fracture. Acta Orthop Scand 1989; 60 (01) 60-62
- 43 Davis TR, Buchanan JM. A controlled prospective study of early mobilization of minimally displaced fractures of the distal radial metaphysis. Injury 1987; 18 (04) 283-285
- 44 Dias JJ, Wray CC, Jones JM, Gregg PJ. The value of early mobilisation in the treatment of Colles' fractures. J Bone Joint Surg Br 1987; 69 (03) 463-467
- 45 McAuliffe TB, Hilliar KM, Coates CJ, Grange WJ. Early mobilisation of Colles' fractures. A prospective trial. J Bone Joint Surg Br 1987; 69 (05) 727-729
- 46 Millett PJ, Rushton N. Early mobilization in the treatment of Colles' fracture: a 3 year prospective study. Injury 1995; 26 (10) 671-675
- 47 Stoffelen D, Broos P. Minimally displaced distal radius fractures: do they need plaster treatment?. J Trauma 1998; 44 (03) 503-505
- 48 de Bruijn HP. Functional treatment of Colles fracture. Acta Orthop Scand Suppl 1987; 223 (223) 1-95
- 49 Dowrick AS, Gabbe BJ, Williamson OD, Cameron PA. Outcome instruments for the assessment of the upper extremity following trauma: a review. Injury 2005; 36 (04) 468-476
- 50 Kwok IHY, Leung F, Yuen G. Assessing results after distal radius fracture treatment: a comparison of objective and subjective tools. Geriatr Orthop Surg Rehabil 2011; 2 (04) 155-160