Application of Removable Wrist Splint in the Management of Distal Forearm Torus Fractures

Mobarakeh, Mahmoud Karimi; Nemati, Ali; Noktesanj, Reza; Fallahi, Amirhossein; Safari, Saeed

doi:10.5812/traumamon.5094

Cited by 19 publications

(9 citation statements)

References 8 publications

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“…Of further concern, the utilization of radiographic and clinical follow-up, the duration of follow-up and the prescribed duration of immobilization were greater than the recent evidence suggests is necessary for safe management. 2 , 6 , 9 , 10 , 17 , 18 Additionally, when comparing the early and late groups to evaluate for changes in practice patterns over the study period, we identified no statistically significant differences in the metrics studied. Together, these results suggest the enduring tendency to over-treat this injury.…”

Section: Discussionmentioning

confidence: 82%

“…The benefits of splinting have been seen in regards to function, hygiene, cost, convenience and patient and caregiver satisfaction without increased risk of treatment failure. 2 , 6 , 9 , 10 , 17 , 18 Furthermore, although we opted to exclude non-torus fractures of the wrist (i.e. greenstick and transverse) from the current study, a 2010 randomized controlled trial by Boutis et al 19 suggests that these injuries may also be safely managed with a removable device for four weeks.…”

Section: Discussionmentioning

confidence: 99%

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Buckling down on torus fractures: Has evolving evidence affected practice?

Williams

Alvarado

Montoya-Williams

et al. 2018

Journal of Children's Orthopaedics

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PurposeThe purpose of this study was to evaluate the management of paediatric torus fractures of the distal forearm in current practice in light of growing evidence supporting a ‘minimalist’ approach with splint immobilization and limited follow-up. We hypothesized that ‘traditional’ cast-based management has persisted despite alternative evidence.MethodsA retrospective review was performed of a consecutive series of paediatric patients diagnosed with torus fractures of the distal forearm between 2011 and 2014. Records were reviewed to abstract the type of immobilization (splint versus cast) prescribed at each visit, number of radiographic exams, duration of immobilization, number of clinical visits and complications. The primary outcome was the proportion of patients exclusively managed in splints. Injuries were grouped based on treatment into a cast group (CG) and a splint group (SG) for statistical analyses. Additionally, injuries were grouped by epoch of time to determine if immobilization usage patterns evolved.ResultsA total of 240 forty injuries met criteria for inclusion. Of these, 16 (6.7%) were exclusively splinted (SG). Relative to the CG, the SG had fewer clinical visits (p < 0.001), fewer radiographic exams (p < 0.001) and a shorter total encounter time (p = 0.015). No change in immobilization use occurred over the study period. In all, 21 (9.4%) of the CG experienced complications. No clinically significant displacements occurred in either group.ConclusionCast utilization and frequent radiographic follow-up remain prevalent at our institution in the management of paediatric torus fractures. Splint-only management was associated with fewer clinical visits, fewer radiographic exams and a shorter total encounter time.Level of Evidence Level IIITherapeutic retrospective cohort study

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Buckling down on torus fractures: Has evolving evidence affected practice?

Williams

Alvarado

Montoya-Williams

et al. 2018

Journal of Children's Orthopaedics

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“…Within Category C effect sizes were calculated for one study [ 84 ] and odds ratios for three studies [ 79 – 81 ]. O’Connor et al [ 84 ] compared a plaster cast to a wrist splint for a Colles’ fracture with no differences in participant satisfaction or pain evident between the groups.…”

Section: Resultsmentioning

confidence: 99%

“…Harding et al [ 80 ] compared a metacarpal brace to neighbour strapping with the brace group more likely to return to work within 3 weeks (OR: 0.04 (0.01 to 0.15)) and more satisfied with the intervention (OR: 0.80 (0.26 to 2.44)). Karimi Mobarakeh et al [ 81 ] compared a plaster cast to a wrist splint with the splint more beneficial in terms of convenience (OR: 0.72 (95% CI 0.26 to 1.99)), but the plaster cast was more beneficial in relieving pain (OR: 1.59 (0.79 to 3.18)).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions

et al. 2018

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BackgroundAssistive products are items which allow older people and people with disabilities to be able to live a healthy, productive and dignified life. It has been estimated that approximately 1.5% of the world’s population need a prosthesis or orthosis.ObjectiveThe objective of this study was to systematically identify and review the evidence from randomized controlled trials assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions.MethodsLiterature searches, completed in September 2015, were carried out in fourteen databases between years 1995 and 2015. The search results were independently screened by two reviewers. For the purpose of this manuscript, only randomized controlled trials which examined interventions using orthotic or prosthetic devices were selected for data extraction and synthesis.ResultsA total of 342 randomised controlled trials were identified (319 English language and 23 non-English language). Only 4 of these randomised controlled trials examined prosthetic interventions and the rest examined orthotic interventions. These orthotic interventions were categorised based on the medical conditions/injuries of the participants. From these studies, this review focused on the medical condition/injuries with the highest number of randomised controlled trials (osteoarthritis, fracture, stroke, carpal tunnel syndrome, plantar fasciitis, anterior cruciate ligament, diabetic foot, rheumatoid and juvenile idiopathic arthritis, ankle sprain, cerebral palsy, lateral epicondylitis and low back pain). The included articles were assessed for risk of bias using the Cochrane Risk of Bias tool. Details of the clinical population examined, the type of orthotic/prosthetic intervention, the comparator/s and the outcome measures were extracted. Effect sizes and odds ratios were calculated for all outcome measures, where possible.ConclusionsAt present, for prosthetic and orthotic interventions, the scientific literature does not provide sufficient high quality research to allow strong conclusions on their effectiveness and cost-effectiveness.

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“…Karimi et al in his study has shown good results in torus fractures in patients less than 17 years of age using removable wrist splint. He, however, studied only the patients of less than 17 ( 16 ).Bahari-Kashani et al (2003) studied the intra-articular distal end radius fractures managed by pin and plaster or plating. They concluded that functional scoring, radiological indices, grip strength, and supination pronation were better in the plating group ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Functional Outcome of Distal Radius Fractures Managed by Barzullah Working Classification

Kamal¹,

Khan²,

Farooq³

et al. 2015

Arch Trauma Res

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Background:Management of distal radius fractures (DRFs) is still controversial and may be influenced by the initial fracture classification. Even though numerous classification systems have been proposed in this regard, the evaluation and management of this fracture has remained problematic.Objectives:The purpose of this study was to evaluate the functional outcome of DRF managed on the basis of a new classification. This classification named as Barzullah Working Classification represents a modification of Melone classification, which is based on fracture stability.Patients and Methods:A total of 310 DRFs of patients skeletally matured referred to a tertiary care hospital at a period of 18 months were classified as per the new classification system into four types; metaphyseal stable, metaphyseal unstable, radiocarpal stable, and radiocarpal unstable fractures. They were managed and followed over a mean period of 15.10 ± 5.4 months, and the results were recorded at the final follow-up.Results:The mean age of the patients was 51.22 ± 20.58 years. Most of the patients were females (n=189, 64.19%). The minimal follow up was 6 months with a mean of 15.10 ± 5.4 months. Mean mayo wrist scores were 95 ± 4, 80 ± 7.4, 75 ± 7.4, and 70 ± 6.9, for stable metaphyseal fractures, unstable metaphyseal radial, stable radiocarpal fractures and unstable radiocarpal fractures, respectively. The overall mean mayo wrist functional score was 80.58 ± 12.3 (good results) at final follow up.Conclusions:Various modalities of treatment used differentially in different types of DRFs based on the Barzullah Working Classification give good results in spite of conflicting literature.

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Application of Removable Wrist Splint in the Management of Distal Forearm Torus Fractures

Cited by 19 publications

References 8 publications

Buckling down on torus fractures: Has evolving evidence affected practice?

Buckling down on torus fractures: Has evolving evidence affected practice?

A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions

Functional Outcome of Distal Radius Fractures Managed by Barzullah Working Classification

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