Topology-optimized splint yielded better function after wrist fracture vs. casting
Key takeaways:
- Topology-optimized splint immobilization may be preferred vs. cast immobilization after distal radius fracture surgery.
- Patients who received splint immobilization had better 6-week functional outcomes.
Published results showed patients who received a topology-optimized splint had better functional outcomes after distal radius fracture surgery compared with patients who received traditional cast immobilization.
Researchers performed a multicenter, open-label, analyst-blinded randomized clinical trial of 110 patients (mean age of 64.1 years) who underwent closed manual reduction for a distal radius fracture between Dec. 3, 2021, and March 10, 2023.
According to the study, 54 patients were randomized to receive a topology-optimized splint for 6 weeks after surgery, while 56 patients were randomized to receive a traditional cast for 6 weeks after surgery. Patients were then observed for another 6 weeks of rehabilitation.
The primary outcome measure was the Gartland-Werley (GW) wrist score, with a higher score corresponding to more severe wrist dysfunction. Other outcomes included radiographic outcomes, VAS pain scores, degree of swelling and overall complication rates.
Among all patients, 92% (n = 101) had complete outcome measures at 12-week follow-up. Median GW scores were 15 for the splint group and 17 for the cast group; however, researchers found no clinically significant differences in GW scores between the groups at 12 weeks. Researchers noted shoulder-elbow pain and dysfunction (risk ratio = 0.28) and skin irritation (risk ratio = 0.3) were less common in the splint group.
“The results suggest that the topology-optimized splint provides early relief from pain and improved function for patients, offering effective treatment while mitigating the risks associated with surgery,” the researchers wrote in the study.
Perspective
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Congratulations to Honghong Ma, MS, and colleagues for their article comparing topology-optimized splinting vs. traditional casting in patients with AO type A and B distal radius fractures being treated conservatively. The overall study design is impressive. There is a growing interest in manufacturing 3D-printed orthoses with a paucity of high-quality studies.
Nevertheless, there are a few caveats. Although the initial Gartland-Werley wrist score was significantly improved at 6 weeks in the topology-optimized splint group, these findings did not persist at 12 weeks. The clinical significance of this change is unclear as there is no established minimal clinically important difference for the Gartland-Werley score. Radiological findings showed no difference, supporting that both methods of treatment maintain fracture reduction equally. The authors report decreased complications in the splint group, which demonstrated less shoulder-elbow pain and dysfunction and skin irritation; however, the long-term impact is unknown. Lastly, the study lacked a cost analysis, limiting its generalizability to value-based care settings like in the United States. Further studies are needed to determine the applicability of topology-optimized splinting and its long-term benefits.
References:
Ma H, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2023.54359.
Oud TAM, et al. PLoS One. 2021;doi:10.1371/journal.pone.0260271.
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