Tuesday, July 16, 2024

Comparison of Circumferential Cast and Plaster Splint in Distal Radial Fracture Treatment

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In a recent study, researchers explored the effectiveness of different casting methods for treating adults with displaced distal radial fractures. The study’s findings offer valuable insights into optimizing initial treatment to prevent redisplacement and complications such as disabling malunion or the need for secondary surgery. This research is especially pertinent given the high rate of redisplacement observed in adequately reduced fractures during immobilization.

Study Design and Methods

The study employed a pragmatic, open-label, multicenter, two-period cluster-randomized superiority trial to compare circumferential casting with plaster splinting. Conducted across ten hospitals, the trial included patients aged 18 years and older with displaced distal radial fractures that were acceptably realigned following closed reduction. The primary focus was on the rate of redisplacement within five weeks of immobilization, with secondary outcomes including cast-related complaints, clinical outcomes at three months, patient-reported outcome measures (PROMs), and adverse events over one year.

Key Findings and Analysis

The trial involved 420 patients, divided into two groups: those treated with a plaster splint and those with a circumferential cast. The results showed no significant difference in the rate of fracture redisplacement between the two groups, with 47% for plaster splints and 49% for circumferential casts. Additionally, patients in the plaster splint group reported higher levels of pain during the first week of treatment compared to those in the circumferential cast group. There were no significant differences in cast-related complaints, clinical outcomes, or PROMs between the two groups, and no cases of compartment syndrome were reported.

From a market access perspective, this study highlights the need for healthcare providers to consider both clinical effectiveness and patient comfort when selecting casting methods. The comparable outcomes between the two casting methods suggest that healthcare systems may have flexibility in choosing the most cost-effective option without compromising patient care.

Implications for Clinical Practice

The findings of this study suggest several important considerations for clinical practice:

– The rate of redisplacement is similar between circumferential casts and plaster splints, indicating that either method can be used based on patient-specific factors and resource availability.
– Higher pain levels reported with plaster splints may influence patient satisfaction and overall treatment experience.
– The absence of significant differences in secondary outcomes supports the flexibility of choice between these casting methods in clinical settings.

These insights could guide healthcare providers in making informed decisions that balance cost, patient comfort, and treatment efficacy.

In conclusion, circumferential casting did not demonstrate a significantly different rate of redisplacement compared to plaster splinting. Both methods produced comparable outcomes, providing flexibility in treatment approaches for distal radial fractures.

Original Article:

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Bone Joint J. 2024 Jul 1;106-B(7):696-704. doi: 10.1302/0301-620X.106B7.BJJ-2024-0014.R1.

ABSTRACT

AIMS: It is not clear which type of casting provides the best initial treatment in adults with a distal radial fracture. Given that between 32% and 64% of adequately reduced fractures redisplace during immobilization in a cast, preventing redisplacement and a disabling malunion or secondary surgery is an aim of treatment. In this study, we investigated whether circumferential casting leads to fewer the redisplacement of fewer fractures and better one-year outcomes compared with plaster splinting.

METHODS: In a pragmatic, open-label, multicentre, two-period cluster-randomized superiority trial, we compared these two types of casting. Recruitment took place in ten hospitals. Eligible patients aged ≥ 18 years with a displaced distal radial fracture, which was acceptably aligned after closed reduction, were included. The primary outcome measure was the rate of redisplacement within five weeks of immobilization. Secondary outcomes were the rate of complaints relating to the cast, clinical outcomes at three months, patient-reported outcome measures (PROMs) (using the numerical rating scale (NRS), the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Wrist/Hand Evaluation (PRWHE) scores), and adverse events such as the development of compartment syndrome during one year of follow-up. We used multivariable mixed-effects logistic regression for the analysis of the primary outcome measure.

RESULTS: The study included 420 patients. There was no significant difference between the rate of redisplacement of the fracture between the groups: 47% (n = 88) for those treated with a plaster splint and 49% (n = 90) for those treated with a circumferential cast (odds ratio 1.05 (95% confidence interval (CI) 0.65 to 1.70); p = 0.854). Patients treated in a plaster splint reported significantly more pain than those treated with a circumferential cast, during the first week of treatment (estimated mean NRS 4.7 (95% CI 4.3 to 5.1) vs 4.1 (95% CI 3.7 to 4.4); p = 0.014). The rate of complaints relating to the cast, clinical outcomes and PROMs did not differ significantly between the groups (p > 0.05). Compartment syndrome did not occur.

CONCLUSION: Circumferential casting did not result in a significantly different rate of redisplacement of the fracture compared with the use of a plaster splint. There were comparable outcomes in both groups.

PMID:38945541 | DOI:10.1302/0301-620X.106B7.BJJ-2024-0014.R1

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