Which immobilization is better for distal radius fracture? A
prospective randomized trial
Felipe Andrés Mingo Fernandez
Marta Cuenca Llavall
Xavier Lizano Diez
Fernando Santana Perez
Received: 18 January 2017 /Accepted: 14 May 2017 /Published online: 3 June 2017
SICOT aisbl 2017
Introduction The aim of this study was to determine whether
an above-elbow cast (AEC) is better than a below-elbow cast
(BEC) at maintaining the initial reduction in the orthopaedic
management of a distal radius fracture (DRF).
Methods It is a prospective randomized study carried out in a
single emergency trauma department. There were 72 patients
older than 55 years of age (55–96) with a distal radius fracture
treated orthopaedically. They were randomized into two
groups: group B (AEC 32 patients) and group A (BEC 40
patients). Randomization was done by a computer program.
Four subgroups were constituted according to the instability
criteria: subgroup 4 the most instable fractures. Main outcome
was reduction loss from initial reduction to cast removal: it
was measured using the volar tilt, radial tilt and radial length
on plain radiographs.
Results No differences were observed between group A and B
when analysed globally (volar tilt loss p =0.89radialtiltloss
p = 0.08 ulnar variance p = 0.19). Subgroups analysis revealed
less radial tilt reduction loss in group A in patients within
subgroup 3 (p = 0.02) and 4 (p =0.003).
Discussion Results are in contrast to what was expected.
Limiting prono-supination AEC is supposed to better main-
tain initial fracture reduction. Effect of pronation and supina-
tion as well as distraction of brachioradialis muscle could have
been overestimated until now.
Conclusion The above-elbow cast is not better than the
below-elbow cast in terms of loss reduction. However, the
below-elbow cast more efficiently controls radial tilt
Keywords Distal radius fracture
Fractures of the distal radius (DRF) are one of the most com-
mon among skeletal injuries. With an annual incidence
>600,000 cases in the United States, they suppose an impor-
tant issue in fracture management that represent about 16% of
all fractures. Despite their frequency, there is still a lack of
evidence relative to classification, treatment, needs for reduc-
tion, type of splinting/immobilization and the surgical tech-
nique used .
Conservative treatment has been shown to be safe and ef-
fective when correctly applied. Good results can be achieved
with closed reduction and immobilization, especially in elder-
ly patients .
Many studies have described and compared different
types of immobilization like the sugar tong plaster, radial
plaster cast and cast bracing. To date, there is not enough
evidence to suggest which is best at immobilizing the
DRF. Moreover, it is not possible to find a study compar-
ing below and above-elbow immobilization when a circu-
lar Paris cast is used [3–6]. The purpose of the present
study is to compare the above-elbow and below-elbow
cast for DRF conservative treatment in terms of the dif-
ferent capacities to maintain the initial reduction achieved
in the emergency room. The null hypothesis is that there
are no differences between these two types of cast.
* Carlo Gamba
Hospital del Mar, Barcelona, Spain
International Orthopaedics (SICOT) (2017) 41:1723–1727