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Better radial tilt reduction of distal radius fractures possible with below-elbow casts
Patients with below-elbow casts for distal radius fractures also experienced less elbow stiffness.
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Fractures of the distal radius can be treated with below-elbow or above-elbow casts, however below-elbow casts may be associated with better radiological outcomes, based on results of a prospective study presented at the 16th EFORT Congress in Prague.
Below-elbow casting is a good option for surgeons who wish to conservatively treat a patient with a distal radius fracture, according to Fernando Santana, MD.
“When managing distal radius fractures conservatively, an above-elbow cast is not better than a below-elbow cast. A below-elbow cast is a good option, with good radiological outcomes and without the risk of elbow stiffness,” he told Orthopaedics Today Europe.
The study was among the top 10 posters presented at the congress to be recognized with the Jacques Duparc Award for best poster.
Images: Santana F
Above vs. below
Santana and colleagues conducted a prospective, randomized study of 72 patients with a distal radius fracture who were over 55 years old. All the patients underwent a peri-fracture mepivacaine injection via an aseptic technique and manual closed fracture reduction with fingers traps. They had their wrists immobilized in 15° palmar flexion, 10° ulnar deviation and slight pronation.
The patients were randomized into a below-elbow cast group (A) or an above-elbow cast group (B) based on a computer-generated random ordering. There were no statistically significant differences in fracture characteristics, age distribution, or gender, Santana noted.
A radiographic study of the anteroposterior and profile views were performed at 1 week, 3 weeks and 6 weeks to analyze volar tilt, radial inclination and radial height in all the patients.
Loss of reduction differences
Neither of the groups had any statistically significant differences in their loss of reduction parameters.
Volar tilt loss (P = .89) was 10.8° ± 8.1° for group A and 10.6° ± 10.3° for group B. Radial tilt loss (P = .08) was 4.6° ± 4° for group A and 5.6° ± 4.6° for group B. Radial height loss (P = .19) was 1.4 mm ± 1.7 mm for group A and 0.7 mm ± 6 mm for group B, according to Santana.
Orthopaedic treatment for distal radius fracture is an effective option, but, Santana and colleagues concluded that results from this study showed above-elbow casting proved to be a worse option than below-elbow casting in terms of loss of reduction. Orthopaedic surgeons who apply below-elbow casting to their patients with distal radius fractures also tend to have better control of radial tilt reduction, the investigators noted. – by Robert Linnehan
- Reference:
- Llavall MC, et al. Poster #3081. Presented at: 16th EFORT Congress; May 27-29, 2015; Prague.
- For more information:
- Fernando Santana, MD, can be reached at Hospital del Mar, 23-25 Passeig Maritim, 08003, Barcelona, Spain; email: fernando.santana.perez@gmail.com.
Disclosure: Santana reports no relevant financial disclosures.