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A prospective randomized controlled trial comparing circumferential casting and splinting in displaced Colles fractures

  • Eric Grafstein (a1) (a2), Rob Stenstrom (a1) (a2), Jim Christenson (a1) (a2), Grant Innes (a3) (a4), Robert MacCormack (a2) (a5), Colin Jackson (a2) (a5), Keith Stothers (a2) (a5) and Tom Goetz (a2) (a5)...
Abstract
Objective:

Our primary objective was to determine the effectiveness of 3 immobilization methods (circumferential casting [CC], volar–dorsal splinting [VDS] and modified sugar-tong [MST] splinting) in maintaining the position of displaced distal radius fractures after successful closed reduction. Our secondary objective was to assess long-term functional outcomes associated with immobilization with fibreglass splinting versus standard CC in patients maintaining initial nonoperative reductions.

Methods:

We conducted a prospective randomized single-blind controlled trial in patients over 18 years of age who presented to the emergency department with a displaced fracture of the distal radius requiring closed reduction. The primary outcome was loss of reduction (defined as radiologic slippage or the need for surgical fixation during the 3–4 week primary immobilization period after initial successful reduction). Secondary outcomes included DASH (disabilities of the arm, shoulder and hand) score, return to work, activities of daily living, wrist pain, range of motion and grip strength assessed at 8 weeks and 6 months.

Results:

Thirty participants were randomly assigned to receive MST splinting, 31 to receive VDS and 40 to receive CC. Baseline characteristics were similar among groups. Radiographic loss of reduction occurred in 16% (95% confidence interval [CI] 3.1%–28.9%) of participants in the VDS group, 20% (95% CI 7.6%–32.4%) in the CC group and 30% (95% CI 13.6°%–46.4°%) in the MST splinting group (p = 0.17). Based on multivariate analysis of variance, functional outcomes at 8 weeks were similar among groups (p = 0.89). DASH scores at 8 weeks and 6 months were similar among groups, based on 1-way analysis of variance (p > 0.25).

Conclusion:

Rates of loss in anatomic position were not statistically significant among the 3 types of dressings used. However, there was a clinically important trend of increased loss of reduction with the use of MST splinting. Functional outcomes at 8 weeks and 6 months were not significantly different between CC, VDS and MDS splinting. Ease of application and familiarity with use should guide clinical decisions when choosing a dressing type for displaced Colles fractures.

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Copyright
Corresponding author
Emergency Department, St. Paul's Hospital, 1081 Burrard St., Vancouver BC V6Z 1Y6; robstenstrom@shaw.ca
References
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1.Thompson, PW, Taylor, J, Dawson, A. The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in Dorset, UK. Injury 2004;35:462–6.
2.Bucholz, RW, Heckman, JD, editors. Rockwood and Green’s fractures inadults. 5th ed. Philadelphia (PA): Lippincott Williams and Wilkins; 2001. p. 118–28, p. 815–27.
3.Younger, ASE, Curran, P, McQueen, MM. Backslabs and plaster casts: Which will best accommodate increasing compartmental pressures? Injury 1990;21:179–81.
4.Wytch, R, Ashcroft, GP, Ledingham, WM, et al.Modern splinting bandages. J Bone Joint Surg Br 1991;73:8891.
5.Aladin, A, Earnshaw, SA, Moran, GC. Control of forearm rotation during nonoperative management of Colles’ Fracture: a prospective randomized controlled trial. Monroe (NY): HWB Foundation; 2001. Available:http://www.hwbf.org/ota/am/ota01/otapa/OTA01952.htm (accessed 2009 Mar. 18).
6.Schmalholz, A. Closed reduction of axial compression in Colle’s fractures is hardly possible. Acta Orthop Scand 1989;60:57–9.
7.Kakarlapudi, TK, Santini, A, Shahane, SA, et al.The cost of treatment of distal radius fractures. Injury 2000;31:229–32.
8.O’Connor, D, Mullett, H, Doyle, M, et al.Minimally displaced Colles’ fractures: a prospective randomized trial of treatment with a wrist splint or a plaster cast J Hand Surg [Br] 2003;28:50–3.
9.Hudak, PL, Amadio, PC, Bombardier, C; Upper Extremity Collaborative Group. Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder, and Hand). Am J Ind Med 1996;29:602–8.
10.Handoll, HH, Madhok, R. Conservative interventions for treating distal radius fractures in adults. Cochrane Database of SystRev. 2002;CD000314.
11.Van der Linden, W, Ericson, R. Colle’s fracture. How should its displacement be measured and how should it be immobilized? J Bone Joint Surg Am 1981;63:1285–8.
12.Stewart, HD, Innes, AR, Burke, FD. Functional cast-bracing for Colle’s fractures. A comparison between cast-bracing and conventional plaster casts. J Bone Joint Surg Br 1984;66:749–53.
13.Moir, JS, Murali, SR, Wardlaw, D, et al.A new functional brace for the treatment of Colle’s fractures. Injury 1995;26:587–93.
14.Ledingham, WM, Wytch, R, Goring, CC, et al.On immediate functional bracing of Colle’s fracture. Injury 1991;22:197201.
15.Dias, JJ, Wray, CC, Jones, JM, et al.The value of early mobilization in the treatment of Colle’s fractures. J Bone Joint Surg Br 1987;69:463.
16.Stoffelen, D, Broos, P. Minimally displaced distal radius fractures: Do they need plaster treatment? J Trauma 1998;44:503–5.
17.Ferris, BD, Thomas, NP, Dewar, ME, et al.Brace treatment of Colle’s fracture. Acta Orthop Scand 1989;60:63–5.
18.de Bruijn, HP. Functional treatment of Colle’s fractures. Acta Orthop Scand 1987;58(Suppl 223):2751.
19.Kelly, AJ, Warwick, D, Crichlow, TPK, et al.Is manipulation of moderately displaced Colle’s fractures worthwhile? A prospective randomized trail. Injury 1997;28:283–7.
20.Gummesson, C, Atroshi, I, Ekdahl, C. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord 2003;4:11.
21.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;20:290–8.
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Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
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