The functional and radiographic outcomes following distal radius fracture treatment in a cast for 4 and 6 weeks in the elderly: A randomized trial

Olech, Jarosław; Kopczyński, Bartosz; Tomczyk, Łukasz; Konieczny, Grzegorz; Kazubski, Krystian; Morasiewicz, Piotr

doi:10.17219/acem/150032

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…The meta-analysis of a comparative study of surgical and conservative treatment by Gutiérrez-Espinoza et al [14] proved the fact that extra-articular fractures had good functional outcomes with nonoperative treatment and surgical treatment with volar locking plates in displaced and partial articular or intraarticular fractures had better outcome and early returned to function. The randomized trial by Olech et al [15] to compare functional and radiological criteria in fractures treated in cast at 4 weeks and 6 weeks showed no significant difference by keeping for 6 weeks except an increase in VT angle. The VAS for pain, radial inclination, radial height, and union rate were similar even in patients whose cast was removed at 4 weeks.…”

Section: Discussionmentioning

confidence: 96%

Current Strategy of Management of Distal Radius Fractures in Geriatric Populations

Lad

2023

jcorth

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The distal radius fractures in geriatric population is one of common emergency admission in hospitals. In view of increasing life expectancy, requirement of continuation of work for having independent life, expectation of better outcome in active elderly population is changed. Non-operatively treated undisplaced and extra-articular fractures give good functional outcome. Intra-articular fractures or grossly displaced fractures in active geriatric patients are treated by open reduction and volar locking plate osteosynthesis. This article described factors to consider for treatment, methodology of treatment for various fracture patterns depending upon physical fitness of patient and radiological parameters. Keywords: distal radius, geriatric, management

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Section: Discussionmentioning

confidence: 96%

Current Strategy of Management of Distal Radius Fractures in Geriatric Populations

Lad

2023

jcorth

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“…Boersma et al compared the effects of a one-week to four- to five-week plaster cast immobilization, showing a decrease in scores for DASH and PRWE, yet this outcome did not display statistical significance between the two groups [ 10 ]. In a randomized controlled trial (RCT) conducted by Olech et al on elderly patients, a lower mean Mayo wrist Sscore was reported in the four-week group compared to the six-week group; however, this difference was not statistically significant [ 11 ].…”

Section: Reviewmentioning

confidence: 99%

“…McAuliffe et al’s study showed a mean VAS score after cast removal in favor of the short-period group with a statistically significant result [ 14 ]. Olech et al’s study revealed a lower VAS score in the four-week group compared to the six-week group, but these differences did not reach statistical significance [ 11 ]. However, a study by Christersson et al reported more pain in the short-term group, though this difference was not significant [ 12 ].…”

Section: Reviewmentioning

confidence: 99%

Short Versus Regular Periods of Cast Immobilization for Distal Radial Fractures: A Systematic Review and Meta-Analysis

Sayudo,

Sudarman,

Fernandes

et al. 2024

Cureus

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The current research on the recommended durations for cast immobilization in adults with distal radial fractures (DRFs) lacks a clear consensus or definitive conclusion. The standard practice involves casting immobilization for five to six weeks. The debate revolves around the potential benefits of shorter periods (three to four weeks) without compromising patient outcomes. While previous research has delved into this subject through systematic reviews, our study stands out by conducting a meta-analysis, aiming for a more precise understanding of whether short or regular cast immobilization duration proves more effective for treating DRFs. A systematic search was conducted across PubMed, Embase, and the Cochrane Library databases to identify relevant studies. The focus was on comparing the outcomes of DRFs between short (three to four weeks) and regular (five to six weeks) periods of cast immobilization. The evaluated parameters include the shortened disabilities of the arm, shoulder, and hand questionnaire (quick (q) DASH); patient-rated wrist evaluation (PRWE); visual analog scale (VAS) score after cast removal; total complications; and the occurrence of complex regional pain syndrome (CRPS). Data synthesis employed the random-effects models, presenting the results as mean difference (MD) and weighted odds ratio (OR) with corresponding 95% confidence intervals (CI). We included three randomized controlled trials (RCTs) with 252 patients, of whom 125 (49.6%) were immobilized in a cast for three to four weeks. The average age of participants was 61.20 years, and the follow-up duration was one year. The QDASH scores were significantly lower at 12 weeks (MD -6.72; 95% CI -10.76 to -2.69; p = 0.001), six months (MD -4.46; 95% CI -7.42 to -1.50; p = 0.003), and one year (MD -4.89; 95% CI -7.45 to -2.33; p = 0.0002) in patients treated with short periods compared to those with regular periods. The PRWE scores at six months (MD -2.33; 95% CI -8.10 to 3.43; p=0.43) did not significantly differ between groups. Also, the PRWE scores were significantly lower at one year (MD -4.93; 95% CI -9.03 to -0.82; p = 0.02) in the shorter cast-immobilization-period group. There were no significant differences in VAS score after cast removal, total complications, or CRPS. The meta-analysis of RCTs on DRFs reveals that shorter periods of cast immobilization lead to better patient-reported functional outcomes (qDASH and PRWE). This suggests a potential benefit of reducing the immobilization duration for DRF patients, offering clinicians valuable insights for improved patient care and informed decision-making in clinical practice.

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“…A prospective RCT evaluating the functional results and costs of the above 2 casting positions in patients aged 65 years and older with DRFs found that VFUD is not superior to FC; further cost analyses reveal that overall costs from VFUD are nearly twice those from FC [30]. As to the period of casting time, an RCT compared the functional and radiographic outcomes following treatment of DRFs in a cast for 4 and 6 weeks in the elderly; The Visual Analogue Scale (VAS) pain score, Mayo Wrist Score (MWS), and VAS activity score are similar between the 2 study groups, and there is no significant between-group difference in terms of radial inclination, union rate, radial height, or bone union [31]. In comparison with surgical treatments, cast immobilization (CI) is non-inferior to VLPF after 1 year in patients aged 65 years and older [32].…”

Section: Non-surgical Treatmentmentioning

confidence: 99%

Current Management and Volar Locking Plate Fixation with Bone Cement Augmentation for Elderly Distal Radius Fractures—An Updated Narrative Review

Tai,

Chu,

et al. 2023

JCM

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Distal radius fractures (DRFs) are the most common among all kinds of fractures with an increase in incidence due to the rapidly expanded size of the elderly population in the past decades. Both non-surgical and surgical treatments can be applied for this common injury. Nowadays, more and more elderly patients with DRFs undergo surgical treatments to restore pre-injury activity levels faster. However, optimal treatment for geriatric DRFs is still debated, and careful evaluation and selection of patients are warranted considering clinical and functional outcomes, and complications following surgical treatments. Furthermore, osteoporosis is a predominant factor in elderly DRFs mostly deriving from a low-energy trauma, so many treatment modalities are developed to enhance better bone healing. Among various options for bone augmentation, bone cement is one of the most widely used measures. Bone cement such as calcium phosphate theoretically improves fracture stability and healing, but whether the elderly patients with DRFs can significantly benefit from surgical fixation with bone cement augmentation (BCA) remains controversial. Hence, in the present review, the latest literature regarding current concepts of management and evidence about volar locking plate fixation (VLPF) with BCA for elderly DRFs was searched in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science; out of >1000 articles, full texts of 48 and 6 articles were then examined and analyzed separately for management and VLPF with BCA for elderly DRFs. We aim to provide the readers with updates concerning the above issues.

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The functional and radiographic outcomes following distal radius fracture treatment in a cast for 4 and 6 weeks in the elderly: A randomized trial

Cited by 5 publications

References 23 publications

Current Strategy of Management of Distal Radius Fractures in Geriatric Populations

Current Strategy of Management of Distal Radius Fractures in Geriatric Populations

Short Versus Regular Periods of Cast Immobilization for Distal Radial Fractures: A Systematic Review and Meta-Analysis

Current Management and Volar Locking Plate Fixation with Bone Cement Augmentation for Elderly Distal Radius Fractures—An Updated Narrative Review

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