No benefit for elbow blocking on conservative treatment of distal radius fractures: A 6-month randomized controlled trial

Abstract

Purpose For displaced distal radius fracture, this trial aimed to compare an above-elbow (AE) and below-elbow (BE) cast at the end of a 24-week follow-up using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as a primary outcome. Methods This is a clinical trial with parallel groups (1:1) and a blinded evaluator. There are two non-surgical interventions: AE and BE. A total of 128 adult patients with acute (up to 7 days) displaced distal radius fracture of type A2-3, C1-3 by the AO classification were included. The follow-up was 24 weeks. The primary outcome was the DASH questionnaire at 24 weeks. Secondary outcomes were the maintenance of reduction by the evaluation of radiographic parameters, pain measured by VAS, PRWE, objective functional evaluation and rate of adverse effects. Results The difference between the two groups in the DASH score at 24 weeks was not significant, with the mean (95% CI) DASH score being AE: 9.44 (2.70 to 16.17) vs. BE: 9.88 (3.19 to 16.57) (p = 0.895). The above-elbow group had a significantly greater worsening of the mean DASH score from baseline to 2 weeks (p < 0.001). No statistically significant differences were found between the 2 groups in any of the other follow-up assessments. Objective functional evaluation, PRWE, radiographical measures and rates of reduction loss were similar between groups. Above-elbow casting resulted in more adverse effects (mostly shoulder pain; 19 events vs. 9 events); RR = 0.39 (0.19–0.94); p = 0.033 at the end of six-month follow-up. Conclusions This study did not demonstrate a difference between above-elbow and below-elbow cast in terms of DASH outcome at 6 months in non-surgical treatment of deviated distal radius fractures. However, below-elbow casting is less debilitating during the treatment period, has comparable performance in maintaining the reduction, and is related to fewer minor adverse effects than above-elbow casting.

Short arm cast is as effective as long arm cast in maintaining distal radius fracture reduction: Results of the SLA-VER noninferiority trial

“…One explanation could be that the time of immobilization may have been too short to result in significant elbow stiffness or that the absence of elbow injury might have contributed to preserving joint mobility. This finding is also reported by Okamura et al [ 11 ]. Finally, it may be that DASH scores are not the most appropriate way to assess cast comfort.…”

“…The hypothesis that short arm casts might perform as well as long arm casts in maintaining the reduction of DRFs has been tested in a number of previous studies. These superiority randomized controlled trials (RCTs) have not found a significant difference in outcome and risk of loss of reduction between below elbow cast (BEC) and above elbow cast (AEC)[ 6 - 11 ]. However, the absence of any significant difference in these studies does not necessarily indicate equivalence[ 12 ].…”

Comparison of above elbow and below elbow immobilisation for conservative treatment of distal end radius fracture in adults: A systematic review and meta-analysis of randomized clinical trials

“… 12 , 13 , 14 , 15 , 16 , 17 Random sequence generation ( n = 6) 12 , 13 , 14 , 15 , 16 , 17 , and allocation concealment ( n = 4) 12 , 13 , 15 , 17 were the strength of the included studies. Attrition bias (high risk) across all the studies and detection bias (unclear risk) 14 , 15 , 16 , 17 across 4 studies were commonest biases noted. High heterogeneity ( I 2 > 75%) was noted among all the studies.…”

A comparison of the functional results and costs of functional cast and volar-flexion ulnar deviation cast at 2-year follow-up in 105 patients aged 65 and older with dorsally displaced distal radius fracture: A randomized controlled trial

“…The best casting position for the wrist, the duration of immobilization, and the best material for the cast are yet to be determined, Handoll & Madhok [ 2 ]. However, a circular cast or an above-elbow cast does not seem to be necessary, Wik et al [ 18 ]; Caruso et al [ 3 ]; Okamura et al [ 19 ]. Some studies have also suggested that dorsal flexion seems to be superior to palmar flexion in functional results Gupta [ 5 ]; Grle et al, [ 20 ]; Rajan [ 21 ].…”