The Ewha Medical Journal
Ewha Womans University School of Medicine
Original Article

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

Maria Florencia Deslivia1,3, Claudia Santosa1,3, Sherly Savio1,*, Erica Kholinne2,3, Made Karna1, Anak Agung Gde Yuda Asmara1
1Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof. Dr. IGNG Ngoerah Hospital, Denpasar 80113, Indonesia.
2Faculty of Medicine, Universitas Trisakti, Jakarta 11440, Indonesia.
3Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta 10440, Indonesia.
4Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta 10440, Indonesia.
*Corresponding Author: Sherly Desnita Savio, Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof. Dr. IGNG Ngoerah Hospital, Denpasar 80113, Indonesia. E-mail: sherlydsavio@gmail.com.

© Copyright 2024 Ewha Womans University School of Medicine. This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: Aug 21, 2024; Revised: Sep 14, 2024; Accepted: Sep 15, 2024

Published Online: Oct 31, 2024

Abstract

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).

Keywords: Consensus; Conservative treatment; Surgical casts; Visual analog scale; Wrist fractures