Short Forearm Casting Versus Below-elbow Splinting for Acute Immobilization of Distal Radius Fractures

Objectives (include all primary and secondary objectives)

To determine the success of sugar tong splinting versus short arm casting for maintenance of reduction of closed distal radius fractures and to compare the functional outcomes in patients treated with sugar tong splinting versus short forearm casting as guidance for immediate post-reduction immobilization of these fractures.

Primary objectives:

Background (briefly describe pre-clinical and clinical data, current experience with procedures, drug or device, and any other relevant information to justify the research)

• Koval et al. randomized patients to long-arm versus short-arm splinting of post-reduction closed distal radius fractures and reported comparable maintenance of reduction with better functional scores in patients immobilized in a short-arm splint and thus recommended this method for immediate post-reduction immobilization of closed distal radius fractures (Bong et al. 2006).
• Grafstein et al. randomized 101 adult patients with closed distal radius fractures to sugar tong splinting versus above-elbow circumferential casting versus above-elbow volar-dorsal splinting for immediate post-reduction immobilization and followed patients closely for 3 to 4 weeks. They reported no significant difference in loss of reduction, pain scores, range of motion, or Activities of Daily Living (ADLs) between the three methods of immobilization and thus recommended treatment with any method with which the treating physician is most comfortable (Grafstein et al., 2010).
• Millet and Rushton randomized 99 women with closed distal radius fractures to below elbow plaster casts versus initial plaster casting followed by flexible casting to allow early joint range of motion and reported increased comfort, grip scores and joint mobility in early treatment period without negative effects of early motion and thus concluded that early mobilization can be a beneficial treatment option (Millet and Rushton, 1995).
• Pool prospectively studied range of motion and radiographic parameters over a two year period in over 200 patients with Colles' fractures treated with five different combinations of above- and below-elbow immobilization and concluded that while all patients went onto union and adequate function, those immobilized in above-elbow plaster lost some degree of supination. He found no benefit to above-elbow immobilization and recommended only below-elbow post-reduction immobilization (Pool, 1973).
• Sarmiento reviewed a case series of 44 patients with intra-articular distal radius fractures treated initially with an above-elbow cast initially and transitioned early to a brace allowing elbow and wrist range of motion while restricting pronation-supination and concluded that although fracture collapse did occur, functional results were good and the early mobilization reduced the stiffness and incapacitation associated with treatment of distal radius fractures (Sarmiento et al.)