![]() ![]() Patients seen by the Orthopaedics team of our Emergency Department (ED) who met the inclusion criteria were asked to provide informed written consent, and allocated to two groups, short cast (SC) and long cast (LC). The secondary objective of the study was to determine whether or not there is a direct correlation between radiological parameters and functional outcomes in such patients. The initial hypothesis was that the short cast would be equally as effective as the long cast in treating this type of fracture. Hence, the aim of this prospective randomised study was to shed more light on the issue by comparing the capacity of long plaster casts (above-elbow, LC) and short plaster casts (below-elbow, SC) to maintain the reduction of extra-articular distal radius fractures with dorsal displacement (2R3A2.2, according to the AO/OTA classification). To date, however, there is no clear definition of the precise indications for short casts in treatment. suggest that an above-elbow plaster cast is necessary to maintain good fracture reduction, but other authors have highlighted the fact that immobilising the elbow joint is not always necessary in this clinical context, and that a splint or so-called below-elbow cast (antebrachial–metacarpal) is sufficient to treat some forms of DRF. In particular, one aspect that remains controversial is the choice of plaster cast type to be used in cases in which conservative treatment is considered appropriate. ĭespite its frequency, management of DRF is still extremely variable even today, there are no clear indications as to the best treatment (conservative or surgical) for the different fracture subtypes. In this latter group, wrist fractures often occur through low-energy trauma events such as falling onto the palm with the wrist extended. DRFs are most often encountered in two distinct groups of patients, namely young people with good bone density mineralization, who typically receive this injury via high-energy trauma and the elderly, predominantly females with poor bone density mineralization. Distal radius fractures are one of the most common types of fractures accounting up to 18% of all fractures in the adults in 2001, it was reported that 640,000 people in the USA were treated for wrist fracture. Registred 20 August 2019.ĭistal radial fractures (DRF), whose main characteristics were first described by the Irish surgeon Sir Abraham Colles in 1814, are common traumatic injuries. Radiological parameters outside the range conventionally considered acceptable do not preclude a satisfactory clinical outcome. ConclusionĪs there were no significant differences between short casts and long casts in terms of fracture reduction maintenance or clinical outcomes, short casts are an effective method of post-reduction immobilisation in AO/OTA 2R3A2.2 fracture of the radius. No statistically significant differences in clinical outcomes were found between patients who presented acceptable radiographic parameters at follow-up and those who did not. Short cast group patients displayed better Mayo elbow score at follow-up 2 (4 weeks), but this difference was no longer statistically significant at follow-up 3 (12 weeks). At follow-up, there were no statistically significant differences between the two types of cast in terms of RI, RH, UV or PT, or Mayo wrist or DASH scores. Patient demographic and baseline radiological parameters were similar between groups. Furthermore, to evaluate correlations between radiological parameters and functional outcomes, patients were divided into two groups according to whether or not their radiological parameters at Follow-ups 2 and 3 were acceptable, i.e. Baseline radiological parameters, radial inclination (RI), radial height (RH), ulnar variance (UV) and palmar tilt (PT) were taken, and compared with clinical (DASH, Mayo Wrist and Mayo Elbow) and radiological scores taken at 7–10 days, 4 weeks and 12 weeks. Seventy-four eligible patients with AO/OTA 2R3A2.2 fractures treated with closed reduction and cast immobilisation were randomised to the long cast group ( n°= 37) or to the short cast group ( n°= 37). Hence, we conducted a two-arm, parallel-group, prospective randomised trial to compare the capacity of long casts (above-elbow) and short casts (below-elbow) to maintain the reduction of extra-articular distal radius fractures with dorsal displacement (AO/OTA classification: 2R3A2.2). Distal radial fractures are common traumatic injuries, but their management remains controversial also in case of conservative treatment regarding the type of immobilisation. ![]()
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