Long term outcome comparison of cast immobilization methods in distal radius fracture: a systematic review of randomized controlled trials

Objectives: The conservative treatment method for distal radius fracture typically involves closed reduction and immobilization with a plaster cast. However, there remains a lack of clear consensus regarding the optimal method and duration of immobilization. This study aimed to examine the functional outcomes of various methods of applying a plaster cast for the treatment of stable distal radius fracture. Methods: A systematic search was performed in accordance with PRISMA guidelines for studies in the last 5 years. Inclusion criteria were Randomized Controlled Trials of non-operative treatment for distal radius fracture. We excluded short term follow-up (<3 months), ongoing trials, and studies not directly addressing the fracture. The use of sugar tong/ non-circular immobilization was also excluded. The outcomes assessed were subjective (Disabilities of Arm Shoulder and Hand score, Patient-Rated Wrist Evaluation score, Mayo Wrist Score, and Visual Analog Scale) and objective outcomes (complication rate and radiological parameter). Results: We included 7 articles from 2017-2022 according to the inclusion criteria. There was a total of 542 fractures, all with greater female proportion and mean age of >50 years old. Short arm cast and long arm cast yield similar functional and radiological outcome. Longer immobilization period should be considered (>3 weeks) to prevent re-displacement. Conclusion. In stable fractures treated conservatively, the use of short arm cast and long arm cast yielded comparable functional outcome in elderlies. Immobilization of at least 3 weeks is recommended, where it offered similar clinical and radiological outcomes compared to longer immobilization period (Level of evidence: Level 2A).