Cast immobilization duration for distal radius fractures, a systematic review

Abstract

Purpose: The optimal duration of immobilization for the conservative treatment of non- or minimally displaced and displaced distal radius fractures remains under debate. This research aims to review studies of these treatments to add evidence regarding the optimal immobilization period.

Methods: A comprehensive database search was conducted. Studies investigating and comparing short (< 3 weeks) versus long (> 3 weeks) immobilizations for the conservative treatment of distal radius fractures were included. The studies were evaluated for radiological and functional outcomes, including pain, grip strength, and range of motion. Two reviewers independently reviewed all studies and performed the data extraction.

Results: The initial database search identified 11.981 studies, of which 16 (involving 1.118 patients) were ultimately included. Patient-reported outcome measurements, grip strength, range of motion, and radiological outcomes were often better after shorter immobilization treatments. Radiological outcomes were better with longer immobilization in two studies and shorter immobilization in one study. Fourteen studies concluded that early mobilization is preferred, while the remaining two studies observed better outcomes with longer immobilization. The data were unsuitable for meta-analysis due to their heterogeneous nature.

Conclusion: Shorter immobilization for conservatively treated distal radius fractures often yield equal or better outcomes than longer immobilizations. The immobilization for non- or minimally displaced distal radius fractures could therefore be shortened to 3 weeks or less. Displaced and reduced distal radius fractures cannot be immobilized shorter than 4 weeks due to the risk of complications. Future research with homogeneous groups could elucidate the optimal duration of immobilization.

Keywords: Cast immobilization; Conservative treatment; Distal radius fractures; Duration of immobilization; Trauma.

Fig. 1

Article selection based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA)

Fig. 2

Overview of the included articles representing the investigated duration of immobilization within each study. The outer limits of the immobilization durations are marked with black dots. The preferred duration of immobilization according to the authors’ conclusions is marked green. Gray boxes represent unfavorable duration of immobilization. The use of only bandage as a treatment is marked as a striped rounded box. An unknown immobilization duration is presented in red. Abbreviations: ND non- or minimally displaced, DR displaced and reduced, OR operation, RC retrospective cohort, W weeks, * = additional immobilization is given after the removal of the cast

Fig. 3

Risk of bias assessment and level of evidence