Two casting methods compared in patients with Colles' fracture: A pragmatic, randomized controlled trial.

Area of Science:

• Orthopedic surgery
• Traumatology
• Geriatric medicine

Background:

• Distal radius fractures are common, particularly in elderly patients.
• Wrist immobilization in a cast is the standard treatment.
• Limited research compares different cast immobilization techniques.

Purpose of the Study:

• To compare the efficacy of volar-flexion and ulnar deviation cast versus functional cast position for dorsally displaced distal radius fractures in elderly patients.

Main Methods:

• A pragmatic, randomized, controlled trial was conducted in three Finnish emergency centers.
• 105 elderly patients (mean age 73.5 years) with distal radius fractures were randomized.
• Outcomes included patient-rated wrist evaluation (PRWE) score, Quick-DASH, grip strength, quality of life, and complications over 12 months.

Main Results:

• The functional cast position showed a non-significant trend towards better PRWE scores (mean difference -4.9, p=.24).
• Operative treatment for lost reduction occurred in 8% of the functional cast group and 13% of the volar-flexion group.
• No significant differences were observed in secondary outcomes or complications.

Conclusions:

• While not statistically significant, the functional cast position may be superior to volar-flexion and ulnar deviation casting for distal radius fractures in the elderly.
• Further research is warranted to confirm these findings and optimize casting techniques.