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J Wrist Surg 2019; 08(01): 043-048
DOI: 10.1055/s-0038-1668155
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Non- or Minimally Displaced Distal Radial Fractures in Adult Patients: Three Weeks versus Five Weeks of Cast Immobilization—A Randomized Controlled Trial

A. Bentohami   *
1   Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
,
E. A. K. van Delft   *
1   Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
2   Department of Surgery, VU University Medical Center, VU University, Amsterdam, The Netherlands
,
J. Vermeulen
1   Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
,
N. L. Sosef
1   Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
,
N. de Korte
1   Department of Trauma Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
,
T. S. Bijlsma
3   Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
,
J. C. Goslings
4   Department of Trauma Surgery, OLVG West, Amsterdam, The Netherlands
,
N. W. L. Schep
5   Department of Trauma and Hand Surgery, Maasstad Hospital, Rotterdam, The Netherlands
› Author Affiliations Funding None.
Further Information

Publication History

20 March 2018

04 July 2018

Publication Date:
15 August 2018 (online)

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Abstract

Background Patients with non- or minimally displaced distal radial fractures, that do not need repositioning, are mostly treated by a short-arm cast for a period of 4 to 6 weeks. A shorter period of immobilization may lead to a better functional outcome.

Purpose We conducted a randomized controlled trial to evaluate whether the duration of cast immobilization for patients with non- or minimally displaced distal radial fractures can be safely shortened toward 3 weeks.

Materials and Methods The primary outcomes were patient-reported outcomes measured by the Patient-Related Wrist Evaluation (PRWE) and Quick Disability of Arm, Shoulder and Hand (QuickDASH) score after 1-year follow-up. Secondary outcome measures were: PRWE and QuickDASH earlier in follow-up, pain (Visual Analog Scale), and complications like secondary displacement.

Results Seventy-two patients (male/female, 23/49; median age, 55 years) were included and randomized. Sixty-five patients completed the 1-year follow-up. After 1-year follow up, patients in the 3 weeks immobilization group had significantly better PRWE (5.0 vs. 8.8 points, p = 0.045) and QuickDASH scores (0.0 vs. 12.5, p = 0.026). Secondary displacement occurred once in each group. Pain did not differ between groups (p = 0.46).

Conclusion Shortening the period of immobilization in adult patients with a non- or minimally displaced distal radial fractures seems to lead to equal patient-reported outcomes for both the cast immobilization groups. Also, there are no negative side effects of a shorter period of cast immobilization. Therefore, we recommend a period of 3 weeks of immobilization in patients with distal radial fractures that do not need repositioning.

Keywords

conservative treatment - distal radial fractures - wrist fractures - immobilization period

Trial Registration

METC- registratie: M011–059

CCMO-registratie: NL38449 09 11.


Ethical Approval

The article has been written in accordance with the ethical standards of the 1964 Declaration of Helsinki. The Medical Ethical Committee of Noord-Holland has approved the study protocol and informed consent of all patients has been obtained. The confirmation letter of the ethical committee will be submitted as well.


Note

This study was conducted at the Department of Trauma Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2143 TM, Hoofddorp, The Netherlands.


* A. Bentohami and E. A. K. van Delft contributed equally to the research project and manuscript and therefore share the first authorship.


 

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