Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2018 Mar 27;19(1):92.
doi: 10.1186/s12891-018-2007-9.

Above-versus below-elbow casting for conservative treatment of distal radius fractures: a randomized controlled trial and study protocol

Aldo Okamura  1 , Gabriel Maciel de Mendonça  2 , Jorge Raduan Neto  3 , Vinicius Ynoe de Moraes  3 , Flavio Faloppa  3 , João Carlos Belloti  3
Affiliations
Comparative Study

Above-versus below-elbow casting for conservative treatment of distal radius fractures: a randomized controlled trial and study protocol

Aldo Okamura et al. BMC Musculoskelet Disord. .

Abstract

Background: A variety of cast options are available for the non-surgical treatment of distal radius fractures (DRF) in adults. However, the literature is inconclusive regarding the need to immobilize the elbow joint after reduction in order to prevent rotation of the forearm in order to maintain the reduction of DRF. This study aimed to evaluate the best method of immobilization between above-elbow (AE) and below-elbow (BE) cast groups at the end of six-month follow-up.

Methods: This is a randomized clinical trial with parallel groups and a blinded evaluator. There are two non-surgical interventions: AE and BE. Patients will be randomly assigned. A hundred twenty eight consecutive adult patients with acute (up to 7 days) displaced DRF of type A2, A3, C1, C2 or C3 by the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification will be included. The primary outcome will be the maintenance of reduction by evaluation of radiographic parameters and Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH). Secondary outcomes include function measured by Patient Rated Wrist Evaluation (PRWE), pain measured by the Visual Analogue Scale (VAS), objective functional evaluation (goniometry and dynamometry) and rate of complications. Evaluations will be performed at 1, 2, 3, 4, 6, 8, 12 and 24 weeks. For the Student's t-test, a difference of 10 points in DASH score, with 95% confidence interval, a statistical power of 95%, and 20% sampling error. We consider an extra 10% for balancing follow up losses results in 64 patients per group.

Discussion: Results from this study protocol will help to define the need for elbow immobilization in maintenance of reduction, as well as functional performance of below elbow cast versus above elbow cast immobilization during the immobilization period.

Trial registration: NCT03126175 ( http://clinicaltrials.gov ). April 24, 2017.

Keywords: Conservative treatment; Distal radius fracture; Prospective; Randomized; Treatment outcome.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The Regional Ethics Committee of UNIFESP and Hospital Municipal Dr. Fernando Mauro Pires da Rocha have approved the trial and additional papers, including consent form and patient information sheet. Approval number: CAAE 57857216.8.0000.5505 and 57857216.8.3001.5452.

Consent for publication

Not applicable.

Competing interests

The authors declare that there are no conflicts of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of patients included in this study
Fig. 2
Fig. 2
Types of immobilization. Below-elbow cast (a). Above-elbow cast (b)
See this image and copyright information in PMC

References

    1. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001;26(5):908–915. doi: 10.1053/jhsu.2001.26322. - DOI - PubMed
    1. Cui Z, Pan J, Yu B, Zhang K, Xiong X. Internal versus external fixation for unstable distal radius fractures: an up-to-date meta-analysis. Int Orthop. 2011;35(9):1333–1341. doi: 10.1007/s00264-011-1300-0. - DOI - PMC - PubMed
    1. Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC. A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am. 2011;36(5):824–835. doi: 10.1016/j.jhsa.2011.02.005. - DOI - PMC - PubMed
    1. Handoll H, Madhok R. Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003;2(2):CD000314. - PubMed
    1. Lichtman DM, Bindra RR, Boyer MI, Putnam MD, Ring D, Slutsky DJ, et al. Treatment of distal radius fracture. J Am Acad Orthop Surg. 2010;18:180–189. doi: 10.5435/00124635-201003000-00007. - DOI - PubMed

Publication types

Associated data