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AAOS issues new distal radius fracture clinical practice guideline
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Using rigid casts rather than splints for distal radius fractures and applying removable splints when these fractures are nondisplaced were among 29 evidence-based recommendations included in the new clinical practice guideline, Treatment of Distal Radius Fractures, from the American Academy of Orthopaedic Surgeons.
Another key recommendation contained in the recently approved and released guideline developed by an American Academy of Orthopaedic Surgeons (AAOS) workgroup was that fractures with a tendency to fall back the way they were prior to being fixed may heal better if surgically fixed rather than treated with casts.
“The academy created this clinical practice guideline to improve patient care for those sustaining a distal radius fracture,” David Lichtman, MD, chair of the guideline workgroup, stated in an AAOS press release.
“This serves as a point of reference and an educational tool for both primary care physicians and orthopedic surgeons, streamlining possible treatment processes for this ever-so-common problem. While a wide range of treatment options are available, they should always be tailored to individual patients after discussions with their orthopedic surgeons,” he stated.
Consensus recommendations
To formulate the guideline, the workgroup analyzed more than 4,000 journal articles. However, some of the recommendations were based only on consensus among workgroup members due to a lack of evidence-based support for those practices, according to the press release.
The consensus-based recommendations were the following:
- Distal radius fractures treated without surgery should have repeated X-rays for 3 weeks and when use of a splint or cast is discontinued;
- Patients should perform active finger motion exercises following a distal radius fracture diagnosis; and
- Patients with distal radius fractures and unremitting pain need to be re-evaluated promptly by their physician.
Future research
According to the work group, one key question that future research may help answer is whether orthopedic surgeons should perform the same operations and use the same distal radius fracture fixation methods on older patients as they do on those younger.
Lichtman noted in the release that some elderly patients, through weightlifting and regular exercise, have the bone structure of an individual 20 or 30 years younger. He and his colleagues sought to determine whether they can undergo the same treatment as younger patients, but their literature review proved no answers exist at this time, he stated in the release.
“Probably the most valuable part of this exercise was the realization that better studies are needed to precisely determine which current treatments work the best under different clinical circumstances. We also came up with some helpful ideas on how to design future studies,” Lichtman added.
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