Clinical and Radiographic Comparison of Splinting Constructs for Distal Radius Fractures: An Effort to Free the Elbow

Abstract

Objectives: To compare short-term functional outcomes, reduction loss, and rates of surgery for distal radius fractures initially immobilized with a traditional sugar-tong splint versus clamshell splint freeing the elbow.Design: Prospective randomized trial.Setting: Level 1 trauma center.Patients: Eighty-nine consecutive patients sustaining distal radius fractures were enrolled between 2018 and 2020. Short-term first follow-up (1-2 weeks) radiographic parameters and 6 weeks for functional questionnaires were established to assess initial outcomes. Main Outcome Measures:The main outcome measures were reduction loss based on radiographic criteria, rate of surgery, and short-term patient functional outcome using the Disabilities of the Arm, Shoulder, and Hand (DASH) score.Results: There were no differences noted in DASH scores (P-value = 0.8) or loss of reduction (P-value = 0.69), and splint type was not correlated with likelihood to have surgery (P = 0.22). A binomial regression model demonstrated splint type was not a significant predictor variable of loss of fracture reduction in the regression model. Conclusions:These results suggest both sugar-tong splint and clamshell splint construct are acceptable options in the acute management of distal radius fractures.

Comparison of Short-Arm Immobilization and Long-Arm Immobilization in Conservatively Managed Distal Radius Fractures: A Meta-Analysis and Systematic Review

“…They also reported no differences in radiographic outcomes or treatment failure (either loss of reduction or requirement for surgical intervention). The present study supplements the data reported in these reviews by incorporating articles published within the last two years, including studies conducted by Dib et al [ 14 ] and Stevens et al [ 19 ], which collectively constitute over one-third of the cases included in this review. In summary, the current literature leans toward equivocal results regarding the use of SA versus LA immobilization constructs.…”

“…[ 14 ] to 22% as reported by Stevens et al. [ 19 ]. Another limitation is the difference in methods used to describe and classify fracture patterns.…”

“…However, even in SA constructs that consisted of two separate plaster slabs, such as the ones used in the study conducted by Stevens et al. [ 19 ], there were no differences in radiographic parameters or requirements for surgery between the SA and LA constructs. The current study demonstrated a higher rate of conversion to operative treatment in the LA construct cohort, although this was not statistically significant.…”

What’s New in Orthopaedic Trauma

“…In a study of 89 patients randomized to a sugar-tong splint or a clam-shell splint, equivalent DASH scores, loss of reduction rates, and surgical conversion were reported. Thus, avoiding elbow immobilization appears to be safe and may minimize elbow stiffness, although this study did not measure the final elbow range of motion 9 .…”