Two casting methods compared in patients with Colles' fracture: A pragmatic, randomized controlled trial

Lauri Raittio, Antti P Launonen, Teemu Hevonkorpi, Toni Luokkala, Juha Kukkonen, Aleksi Reito, Minna K Laitinen, Ville M Mattila, Lauri Raittio, Antti P Launonen, Teemu Hevonkorpi, Toni Luokkala, Juha Kukkonen, Aleksi Reito, Minna K Laitinen, Ville M Mattila

Abstract

Background: Distal radius fractures are common fractures and the cornerstone of treatment remains immobilization of the wrist in a cast. At present, there is a scarcity of studies that compare different cast immobilization methods. The objective of the study was therefore to compare volar-flexion and ulnar deviation cast to functional cast position in the treatment of dorsally displaced distal radius fracture among elderly patients.

Methods and findings: We performed a pragmatic, randomized, controlled trial in three emergency centers in Finland. After closed reduction of the fracture, the wrist was placed in either volar-flexion and ulnar deviation cast or functional cast position. The follow-up was 12 months. The primary outcome was patient-rated wrist evaluation (PRWE) score at 12 months. The secondary outcomes were Quick-DASH score, grip strength, health-related quality of life (15D), and pain catastrophizing scale. The number of complications was also recorded. In total, 105 participants were included in the study. Of these, 88% were female and the mean age was 73.5 (range 65-94) years. In the primary analysis, the mean difference in patient-rated wrist evaluation measure between groups was -4.9 (95% CI: -13.1.- 3.4., p = .24) in favor of the functional cast position. Operative treatment due to loss of reduction of fracture was performed for four patients (8%) in the FC group and for seven patients (13%) in the volar-flexion and ulnar deviation cast group (OR: 0.63, 95% CI: 0.16-2.1).

Conclusion: In this study, the data were consistent with a wide range of treatment effects when comparing two different cast positions in the treatment of distal radius fracture among elderly patients at 12-month follow-up. However, the functional cast is more likely to be superior when compared to volar-flexion and ulnar deviation cast.

Trial registration: ClinicalTrials.gov identifier: NCT02894983 Accessible: https://ichgcp.net/clinical-trials-registry/NCT02894983.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. The flow diagram of the…
Fig 1. The flow diagram of the study (CONSORT).
aPRWE = patient-rated wrist evaluation.

References

    1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37:691–697. 10.1016/j.injury.2006.04.130
    1. Blatter G, Papp P, Magerl F. A comparison of 2 methods of plastic cast fixation in treatment of loco classico radius fracture. A prospective, randomized study. Unfallchirurg. 1994;97:534–540.
    1. Sarmiento A, Zagorski JB, Sinclair WF. Functional bracing of Colles’ fractures: a prospective study of immobilization in supination vs. pronation. Clin Orthop Relat Res. 1980;146:175–183.
    1. Wahlström O. Treatment of Colles’ Fracture: A Prospective Comparison of Three Different Positions of Immobilization. Acta Orthop Scand. 1982;53:225–228.
    1. Wilson C, Venner RM. Colles’ fracture. Immobilisation in pronation or supination? J R Coll Surg Edinb.1984;29:109–111.
    1. Gupta A. The treatment of Colles’ fracture. Immobilisation with the wrist dorsiflexed. J Bone Jt Surg Br.1991;73-B:312–315. 10.1302/0301-620X.73B2.2005163
    1. Handoll HH, Madhok R. Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003;2 10.1002/14651858.CD000314
    1. Cotton FJ. Dislocations and joint-fractures. WB Saunders; 1910.
    1. Agee JM. External fixation. Technical advances based upon multiplanar ligamentotaxis. Orthop Clin North Am. 1993;24:265–274.
    1. Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg Am. 2000;25:19–28. 10.1053/jhsu.2000.jhsu025a0019
    1. Azzopardi T, Ehrendorfer S, Coulton T, Abela M. Unstable extra-articular fractures of the distal radius: a prospective, randomised study of immobilisation in a cast versus supplementary percutaneous pinning. J Bone Jt Surg Br; 2005;87:837–840. 10.1302/0301-620X.87B6.15608
    1. 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 Jt Surg Am. 2011;93:2146–2153. 10.2106/JBJS.J.01597
    1. Grewal R, MacDermid JC. The risk of adverse outcomes in extra-articular distal radius fractures is increased with malalignment in patients of all ages but mitigated in older patients. J Hand Surg Am. 2007;32:962–970. 10.1016/j.jhsa.2014.08.007
    1. Abbaszadegan H, Jonsson U. External fixation or plaster cast for severely displaced colles’ fractures?: Prospective 1-year study of 46 patients. Acta Orthop Scand. 1990;61:528–530.
    1. McQueen MM, Hajducka C. Redisplaced unstable fractures of the distal radius: A prospecitve randomised comparison of four methods of treatment. J Bone Jt Surg Br. 1996;78:404–409.
    1. Stein H, Volpin G, Horesh Z, Hoerer D. Cast or external fixation for fracture of the distal radius: a prospective study of 126 cases. Acta Orthop Scand. 1990;61:453–456.
    1. Teunis T, Bot AG, Thornton ER, Ring D. Catastrophic Thinking Is Associated With Finger Stiffness After Distal Radius Fracture Surgery. J Orthop Trauma.; 2015;29: e414–20. 10.1097/BOT.0000000000000342
    1. Roh YH, Lee BK, Noh JH, Oh JH, Gong HS, Baek GH. Effect of anxiety and catastrophic pain ideation on early recovery after surgery for distal radius fractures. J Hand Surg Am. 2014;39: 2258–2264. e2. 10.1016/j.jhsa.2014.08.007
    1. Yeoh JC, Pike JM, Slobogean GP, OʼBrien PJ, Broekhuyse HM, Lefaivre KA. Role of Depression in Outcomes of Low-Energy Distal Radius Fractures in Patients Older Than 55 Years. J Orthop Trauma. 2016;30: 228–33. 10.1097/BOT.0000000000000514
    1. Tunis SR, Stryer DB, Clancy CM. Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA. 2003;290:1624–32. 10.1001/jama.290.12.1624
    1. Glasgow RE, Magid DJ, Beck A, Ritzwoller D, Estabrooks PA. Practical clinical trials for translating research to practice: design and measurement recommendations. Med Care. 2005;43:551–7.
    1. Zwarenstein M, Treweek S. What kind of randomised trials do patients and clinicians need? Evid Based Med. 2009;14:101–103. 10.1136/ebm.14.4.101
    1. Raittio L, Launonen A, Hevonkorpi T, Luokkala T, Kukkonen J, Reito A, et al. Comparison of volar-flexion, ulnar-deviation and functional position cast immobilization in the non-operative treatment of distal radius fracture in elderly patients: a pragmatic randomized controlled trial study protocol. BMC Musculoskelet Disord. 2017;18: 401 10.1186/s12891-017-1759-y
    1. Duodecim AFMS. Distal Radius Fracture. Current Care Guideline [Internet]. 2016. Available:
    1. Batra S, Gupta A. The effect of fracture-related factors on the functional outcome at 1 year in distal radius fractures. Injury. 2002;33:499–502.
    1. Anzarut A, Johnson JA, Rowe BH, Lambert RGW, 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;29:1121–1127. 10.1016/j.jhsa.2004.07.002
    1. Walenkamp MMJ, de Muinck Keizer R-J, Goslings JC, Vos LM, Rosenwasser MP, Schep NWL. The Minimum Clinically Important Difference of the Patient-rated Wrist Evaluation Score for Patients With Distal Radius Fractures. Clin Orthop Relat Res. 2015;473: 3235–3241. 10.1007/s11999-015-4376-9
    1. Aktekin CN, Altay M, Gursoy Z, Aktekin LA, Ozturk AM, Tabak AY. Comparison Between External Fixation and Cast Treatment in the Management of Distal Radius Fractures in Patients Aged 65 Years and Older. J Hand Surg Am. W.B. 2010;35: 736–742. 10.1016/J.JHSA.2010.01.028
    1. Sanchez-Sotelo J, Munuera L, Madero R. Treatment of fractures of the distal radius with a remodellable bone cement. J Bone Joint Surg Br. 2000;82-B:856–863. 10.1302/0301-620X.82B6.0820856
    1. Wik TS, Aurstad ÅT, Finsen V. Colles’ fracture: Dorsal splint or complete cast during the first 10 days? Injury. 2009;40:400–404. 10.1016/J.INJURY.2008.08.044
    1. Chan Y-H, Foo T-L, Yeo C-J, Chew WY-C. Comparison between cast immobilization versus volar locking plate fixation of distal radius fractures in active elderly patients, the Asian perspective. Hand Surg. 2014;19:19–23. 10.1142/S021881041450004X
    1. van der Linden W, Ericson R. Colles’ fracture. How should its displacement be measured and how should it be immobilized? J Bone Jt Surg Am. 1981;63:1285–1288.
    1. Rajan S, Jain S, Ray A, Bhargava P. Radiological and functional outcome in extra-articular fractures of lower end radius treated conservatively with respect to its position of immobilization. Indian J Orthop. 2008;42:201–7. 10.4103/0019-5413.40258
    1. Grle M, Miljko M, Grle I, Hodžić F, Glasnik TK-M, 2017 U. Early results of the conservative treatment of distal radius fractures-immobilization of the wrist in dorsal versus palmar flexion. Med Glas. 2017;14:236–243.
    1. Gelberman RH, Szabo RM, Mortensen WW. Carpal tunnel pressures and wrist position in patients with colles’ fractures. J Trauma Acute Care Surg. 1984;24:747–749.

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