Radiographic results after plaster cast fixation for 10 days versus 1 month in reduced distal radius fractures: a prospective randomised study

Albert Christersson, Sune Larsson, Bengt Östlund, Bengt Sandén, Albert Christersson, Sune Larsson, Bengt Östlund, Bengt Sandén

Abstract

Background: The aim of this study was to examine whether reduced distal radius fractures can be treated with early mobilisation without affecting the radiographic results.

Methods: In a prospective randomised study, 109 patients (mean age 65.8 (range 50-92)) with moderately displaced distal radius fractures were treated with closed reduction and plaster cast fixation for about 10 days (range 8-13 days) followed by randomisation to one of two groups: early mobilisation (n = 54, active group) or continued plaster cast fixation for another 3 weeks (n = 55, control group).

Results: For three patients in the active group (6%), treatment proved unsuccessful because of severe displacement of the fracture (n = 2) or perceived instability (n = 1). From 10 days to 1 month, i.e. the only period when the treatment differed between the two groups, the active group displaced significantly more in dorsal angulation (4.5°, p < 0.001), radial angulation (2.0°, p < 0.001) and axial compression (0.5 mm, p = 0.01) compared with the control group. However, during the entire study period (i.e. from admission to 12 months), the active group displaced significantly more than the controls only in radial angulation (3.2°, p = 0.002) and axial compression (0.7 mm, p = 0.02).

Conclusions: Early mobilisation 10 days after reduction of moderately displaced distal radius fractures resulted in both an increased number of treatment failures and increased displacement in radial angulation and axial compression as compared with the control group. Mobilisation 10 days after reduction cannot be recommended for the routine treatment of reduced distal radius fractures.

Trial registration: ClinicalTrail.gov, NCT02798614 . Retrospectively registered 16 June 2016.

Keywords: Closed reduction; Conservative treatment; Distal radius fracture; Early mobilisation; Plaster cast; Prospective; Radiographic evaluation; Randomised.

Figures

Fig. 1
Fig. 1
Flow diagram
Fig. 2
Fig. 2
a Dorsal angulation was measured on the lateral view as the angle between a line connecting the anterior and posterior edge of the distal joint line of radius and a line perpendicular to the long axis of radius. Negative values denote volar angulation whilst positive values refer to dorsal angulation in relation to the line perpendicular to the long axis. The mean value of the uninjured contralateral wrists was −6.9°. b Radial angulation (or radial inclination) was measured on the anteroposterior view as the angle between a line connecting processus styloideus radii and the most ulnar part of the distal radius at the distal radioulnar joint (DRU joint) and a line perpendicular to the long axis of the radius. The mean value of the uninjured contralateral wrists was 21.3°. c Axial compression (or ulnar variance) was measured on the anteroposterior view as the distance between the distal joint line of the radius at the DRU joint and the most distal surface of the caput ulnae along the long axis of the radius. Negative values denote radius being longer than ulna, whilst positive values refer to radius being shorter than ulna. The mean value of the uninjured contralateral wrists was −1.3 mm
Fig. 3
Fig. 3
a Dorsal angulation, b radial angulation and c axial compression from admission to 12 months (mean with 95% confidence interval). Three failures in the 10-day cast group have been excluded

References

    1. Abbaszadegan H, Conradi P, Jonsson U. Fixation not needed for undisplaced Colles’ fracture. Acta Orthop Scand. 1989;60(1):60–2. doi: 10.3109/17453678909150094.
    1. Stoffelen D, Broos P. Minimally displaced distal radius fractures: do they need plaster treatment? J Trauma. 1998;44(3):503–5. doi: 10.1097/00005373-199803000-00014.
    1. Davis TR, Buchanan JM. A controlled prospective study of early mobilization of minimally displaced fractures of the distal radial metaphysis. Injury. 1987;18(4):283–5. doi: 10.1016/0020-1383(87)90015-5.
    1. McAuliffe TB, Hilliar KM, Coates CJ, Grange WJ. Early mobilisation of Colles’ fractures. A prospective trial. J Bone Joint Surg Br. 1987;69(5):727–9.
    1. 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 Am. 1998;23(3):400–1. doi: 10.1016/S0266-7681(98)80067-3.
    1. Millett PJ, Rushton N. Early mobilization in the treatment of Colles’ fracture: a 3 year prospective study. Injury. 1995;26(10):671–5. doi: 10.1016/0020-1383(95)00146-8.
    1. Sarmiento A, Pratt GW, Berry NC, Sinclair WF. Colles’ fractures. Functional bracing in supination. J Bone Joint Surg Am. 1975;57(3):311–7. doi: 10.2106/00004623-197557030-00004.
    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;146:175–83.
    1. 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(3):463–7. doi: 10.2106/00004623-198769030-00021.
    1. Stewart HD, Innes AR, Burke FD. Functional cast-bracing for Colles’ fractures. A comparison between cast-bracing and conventional plaster casts. J Bone Joint Surg Br. 1984;66(5):749–53.
    1. de Bruijn HP. Functional treatment of Colles fracture. Acta Orthop Scand Suppl. 1987;223:1–95. doi: 10.3109/17453678709154162.
    1. Abbaszadegan H, Jonsson U, von Sivers K. Prediction of instability of Colles’ fractures. Acta Orthop Scand. 1989;60(6):646–50. doi: 10.3109/17453678909149595.
    1. Dias JJ, Wray CC, Jones JM. The radiological deformity of Colles’ fractures. Injury. 1987;18(5):304–8. doi: 10.1016/0020-1383(87)90047-7.
    1. Hove LM, Solheim E, Skjeie R, Sorensen FK. Prediction of secondary displacement in Colles’ fracture. J Hand Surg Am. 1994;19(6):731–6. doi: 10.1016/0266-7681(94)90247-X.
    1. Foldhazy Z, Tornkvist H, Elmstedt E, Andersson G, Hagsten B, Ahrengart L. Long-term outcome of nonsurgically treated distal radius fractures. J Hand Surg Am. 2007;32(9):1374–84. doi: 10.1016/j.jhsa.2007.08.019.
    1. Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury. 1989;20(4):208–10. doi: 10.1016/0020-1383(89)90113-7.
    1. Mackenney PJ, McQueen MM, Elton R. Prediction of instability in distal radial fractures. J Bone Joint Surg Am. 2006;88(9):1944–51.
    1. Nesbitt KS, Failla JM, Les C. Assessment of instability factors in adult distal radius fractures. J Hand Surg Am. 2004;29(6):1128–38. doi: 10.1016/j.jhsa.2004.06.008.
    1. Makhni EC, Ewald TJ, Kelly S, Day CS. Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment. J Hand Surg Am. 2008;33(8):1301–8. doi: 10.1016/j.jhsa.2008.04.031.
    1. 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(1):98–100. doi: 10.1080/00016470310013743.
    1. Solgaard S. Function after distal radius fracture. Acta Orthop Scand. 1988;59(1):39–42. doi: 10.3109/17453678809149341.
    1. Dixon S, Allen P, Bannister G. Which Colles’ fractures should be manipulated? Injury. 2005;36(1):81–3. doi: 10.1016/j.injury.2004.03.027.
    1. Leung F, Ozkan M, Chow SP. Conservative treatment of intra-articular fractures of the distal radius—factors affecting functional outcome. Hand Surg. 2000;5(2):145–53. doi: 10.1142/S0218810400000338.
    1. Wilcke MK, Abbaszadegan H, Adolphson PY. Patient-perceived outcome after displaced distal radius fractures. A comparison between radiological parameters, objective physical variables, and the DASH score. J Hand Ther. 2007;20(4):290–8. doi: 10.1197/j.jht.2007.06.001.
    1. Aro HT, Koivunen T. Minor axial shortening of the radius affects outcome of Colles’ fracture treatment. J Hand Surg Am. 1991;16(3):392–8. doi: 10.1016/0363-5023(91)90003-T.
    1. Gliatis JD, Plessas SJ, Davis TR. Outcome of distal radial fractures in young adults. J Hand Surg Am. 2000;25(6):535–43. doi: 10.1054/jhsb.2000.0373.
    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(7):962–70. doi: 10.1016/j.jhsa.2007.05.009.
    1. Brogren E, Wagner P, Petranek M, Atroshi I. Distal radius malunion increases risk of persistent disability 2 years after fracture: a prospective cohort study. Clin Orthop Relat Res. 2013;471(5):1691–7. doi: 10.1007/s11999-012-2767-8.
    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(1):19–28. doi: 10.1053/jhsu.2000.jhsu025a0019.
    1. Jaremko JL, Lambert RG, Rowe BH, Johnson JA, Majumdar SR. Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment? Clin Radiol. 2007;62(1):65–72. doi: 10.1016/j.crad.2006.08.013.
    1. Egol KA, Walsh M, Romo-Cardoso S, Dorsky S, Paksima N. Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Joint Surg Am. 2010;92(9):1851–7. doi: 10.2106/JBJS.I.00968.
    1. Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma. 2009;23(4):237–42. doi: 10.1097/BOT.0b013e31819b24e9.
    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 Joint Surg Am. 2011;93(23):2146–53. doi: 10.2106/JBJS.J.01597.
    1. Clement ND, Duckworth AD, Court-Brown CM, McQueen MM. Distal radial fractures in the superelderly: does malunion affect functional outcome? ISRN Orthop. 2014;2014:189803. doi: 10.1155/2014/189803.
    1. Altissimi M, Antenucci R, Fiacca C, Mancini GB. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res. 1986;206:202–10.
    1. Cohen J. A power primer. Psychol Bull. 1992;112(1):155–9. doi: 10.1037/0033-2909.112.1.155.
    1. Solgaard S. Early displacement of distal radius fracture. Acta Orthop Scand. 1986;57(3):229–31. doi: 10.3109/17453678608994383.
    1. Abbaszadegan H, von Sivers K, Jonsson U. Late displacement of Colles’ fractures. Int Orthop. 1988;12(3):197–9. doi: 10.1007/BF00547163.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa