Pain Perception following Initial Closed Reduction in the Preoperative Care of Unstable, Dorsally Displaced Distal Radius Fractures

Abstract

Introduction Closed reduction and cast immobilization is a common practice as initial treatment for distal radius fractures. This study examines the pain perception that accompanies this approach. Materials and Methods Thirty dorsally displaced distal radius fractures were reduced and casted under finger-trap traction with intravenous analgesics. Patients rated their pain perception on visual analog scale prior to presentation, during reduction, during casting, and for every day until surgery. Closed reduction improved palmar tilt from -26.3 to -10.8 degrees. Surgery improved palmar tilt from -10.8 to +6.1 degrees. Closed reduction improved radial inclination from 15.5 to 19.1 degrees. Surgery improved radial inclination from 19.1 to 21.6 degrees. Mean pain perception was 5.8 at presentation. Reduction increased pain to 7.5 ( p < 0.001), whereas casting was less painful (3.7; p < 0.001). At the evening following casting and the following days until surgery, mean pain was still as high as 4.1, 4.2, 4.1, 3.6, 3.9, 2.8, 3.0, and 3.0, with some patients experiencing more pain than initially. Conclusion Reduction generates significant pain with only minor relief during cast immobilization. The indication for closed reduction prior to cast application is therefore questionable.

Keywords: Colles’ fractures; cast immobilization; closed reduction; complex regional pain syndrome; distal radius fracture; pain perception.

Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1

Palmar tilt and radial inclination of radius.

Fig. 2

This 75-year-old patient with a distal radius fracture presented with an initial pain perception of 6.5 on visual analog scale. Her radius was dorsally displaced by 36 degrees, whereas radial inclination was 20 degrees(A). Closed reduction increased pain to 8 out of 10 despite the IV application of 7.5 mg piritramide and 500 mg novaminsulfon. Reduction thereby improved dorsal tilt to −4 degrees and radial inclination to 22 degrees(B). During cast application, as well as the evening following initial treatment, she perceived a pain of seven. The following 4 days until surgery, she stated to have had pain of 8. Surgery finally improved her radial inclination to an almost physiologic palmar tilt of 4 degrees and a radial inclination of 24 degrees(C, D).