1
|
de Bruijn MAN, van Ginkel LA, Boersma EZ, van Silfhout L, Tromp TN, van de Krol E, Edwards MJR, Stirler VMA, Hermans E. Cast immobilization duration for distal radius fractures, a systematic review. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02494-y. [PMID: 38507086 DOI: 10.1007/s00068-024-02494-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/27/2024] [Indexed: 03/22/2024]
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.
Collapse
Affiliation(s)
- Marcel A N de Bruijn
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Laura A van Ginkel
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
- Faculty of Science and Technology - Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Emily Z Boersma
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
| | - Lysanne van Silfhout
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
| | - Tjarda N Tromp
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
| | - Erik van de Krol
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
- Military Health Organisation, Ministry of Defense, Kromhout Kazerne, Utrecht, The Netherlands
| | - Michael J R Edwards
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
| | - Vincent M A Stirler
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
- Military Health Organisation, Ministry of Defense, Kromhout Kazerne, Utrecht, The Netherlands
| | - Erik Hermans
- Department of Trauma Surgery, Radboud University Medical Center, Geert Grooteplein Zuid 10, Postbox 9101, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
2
|
Sayudo IF, Sudarman JP, Fernandes A, Park JY, Leibovitch L, Machinski E, Mahmoud MO. Short Versus Regular Periods of Cast Immobilization for Distal Radial Fractures: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e54704. [PMID: 38389565 PMCID: PMC10883593 DOI: 10.7759/cureus.54704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 02/24/2024] Open
Abstract
The current research on the recommended durations for cast immobilization in adults with distal radial fractures (DRFs) lacks a clear consensus or definitive conclusion. The standard practice involves casting immobilization for five to six weeks. The debate revolves around the potential benefits of shorter periods (three to four weeks) without compromising patient outcomes. While previous research has delved into this subject through systematic reviews, our study stands out by conducting a meta-analysis, aiming for a more precise understanding of whether short or regular cast immobilization duration proves more effective for treating DRFs. A systematic search was conducted across PubMed, Embase, and the Cochrane Library databases to identify relevant studies. The focus was on comparing the outcomes of DRFs between short (three to four weeks) and regular (five to six weeks) periods of cast immobilization. The evaluated parameters include the shortened disabilities of the arm, shoulder, and hand questionnaire (quick (q) DASH); patient-rated wrist evaluation (PRWE); visual analog scale (VAS) score after cast removal; total complications; and the occurrence of complex regional pain syndrome (CRPS). Data synthesis employed the random-effects models, presenting the results as mean difference (MD) and weighted odds ratio (OR) with corresponding 95% confidence intervals (CI). We included three randomized controlled trials (RCTs) with 252 patients, of whom 125 (49.6%) were immobilized in a cast for three to four weeks. The average age of participants was 61.20 years, and the follow-up duration was one year. The QDASH scores were significantly lower at 12 weeks (MD -6.72; 95% CI -10.76 to -2.69; p = 0.001), six months (MD -4.46; 95% CI -7.42 to -1.50; p = 0.003), and one year (MD -4.89; 95% CI -7.45 to -2.33; p = 0.0002) in patients treated with short periods compared to those with regular periods. The PRWE scores at six months (MD -2.33; 95% CI -8.10 to 3.43; p=0.43) did not significantly differ between groups. Also, the PRWE scores were significantly lower at one year (MD -4.93; 95% CI -9.03 to -0.82; p = 0.02) in the shorter cast-immobilization-period group. There were no significant differences in VAS score after cast removal, total complications, or CRPS. The meta-analysis of RCTs on DRFs reveals that shorter periods of cast immobilization lead to better patient-reported functional outcomes (qDASH and PRWE). This suggests a potential benefit of reducing the immobilization duration for DRF patients, offering clinicians valuable insights for improved patient care and informed decision-making in clinical practice.
Collapse
Affiliation(s)
| | | | - André Fernandes
- Trauma and Orthopaedics, York and Scarborough National Health Service (NHS) Trust, York, GBR
| | - Jae Yong Park
- Medicine and Surgery, Imperial College London, London, GBR
| | | | - Elcio Machinski
- Orthopaedics, State University of Ponta Grossa, Ponta Grossa, BRA
| | - Mohamed O Mahmoud
- Trauma and Orthopaedics, York and Scarborough National Health Service (NHS) Trust, York, GBR
| |
Collapse
|
3
|
de Bruijn MAN, van Ginkel LA, Boersma EZ, van Silfhout L, Tromp TN, van de Krol E, van der Heijden BEPA, Hermans E, Stirler VMA, Edwards MJR. The past, present and future of the conservative treatment of distal radius fractures. Injury 2023; 54 Suppl 5:110930. [PMID: 37923503 DOI: 10.1016/j.injury.2023.110930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 11/07/2023]
Abstract
The distal radius fracture is a common fracture with a prevalence of 17% on the emergency departments. The conservative treatment of distal radius fractures usually consists of three to six weeks of plaster immobilization. Several studies show that one week of plaster immobilization is safe for non- or minimally displaced distal radius fractures that do not need reduction. A shorter period of immobilization may lead to a better functional outcome, faster reintegration and participation in daily activities. Due to upcoming innovations such as three-dimensional printed splints for distal radius fractures, a patient specific splint can be produced which may offer more comfort. Furthermore, these three-dimensional printed splints are expected to be more environmental friendly in comparison with traditional plaster casts.
Collapse
Affiliation(s)
- Marcel A N de Bruijn
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Laura A van Ginkel
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Faculty of Science and Technology - Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Emily Z Boersma
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lysanne van Silfhout
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tjarda N Tromp
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik van de Krol
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Military Health Organisation, Ministry of Defence, Kromhout Kazerne, Utrecht, The Netherlands
| | - Brigitte E P A van der Heijden
- Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Plastic Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
| | - Erik Hermans
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vincent M A Stirler
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Military Health Organisation, Ministry of Defence, Kromhout Kazerne, Utrecht, The Netherlands
| | - Michael J R Edwards
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
4
|
Bevers MSAM, Heyer FL, Wyers CE, van Rietbergen B, Geusens PPMM, Janzing HMJ, Lambers Heerspink O, Poeze M, van den Bergh JP. The contribution of lower-mineralized tissue to the healing of distal radius fractures assessed using HR-pQCT. Bone 2023; 175:116859. [PMID: 37507063 DOI: 10.1016/j.bone.2023.116859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/03/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023]
Abstract
High-resolution peripheral quantitative CT (HR-pQCT) enables quantitative assessment of distal radius fracture healing. In previous studies, lower-mineralized tissue formation was observed on HR-pQCT scans, starting early during healing, but the contribution of this tissue to the stiffness of distal radius fractures is unknown. Therefore, the aim of this study was to investigate the contribution of lower-mineralized tissue to the stiffness of fractured distal radii during the first twelve weeks of healing. We did so by combining the results from two series of micro-finite element (μFE-) models obtained using different density thresholds for bone segmentation. Forty-five postmenopausal women with a conservatively-treated distal radius fracture had HR-pQCT scans of their fractured radius at baseline (BL; 1-2 weeks post-fracture), 3-4 weeks, 6-8 weeks, and 12 weeks post-fracture. Compression stiffness (S) was computed using two series of μFE-models from the scans: one series (Msingle) included only higher-mineralized tissue (>320 mg HA/cm3), and one series (Mdual) differentiated between lower-mineralized tissue (200-320 mg HA/cm3) and higher-mineralized tissue. μFE-elements were assigned a Young's Modulus of 10 GPa (higher-mineralized tissue) or 5 GPa (lower-mineralized tissue), and an axial compression test to 1 % strain was simulated. The contribution of the lower-mineralized tissue to S was quantified as the ratio Sdual/Ssingle. Changes during healing were quantified using linear mixed effects models and expressed as estimated marginal means (EMMs) with 95 %-confidence intervals (95 %-CI). Median time to cast removal was 5.0 (IQR: 1.1) weeks. Sdual and Ssingle gradually increased during healing to a significantly higher value than BL at 12 weeks post-fracture (both p < 0.0001). In contrast, Sdual/Ssingle was significantly higher than BL at 3-4 weeks post-fracture (p = 0.0010), remained significantly higher at 6-8 weeks post-fracture (p < 0.0001), and then decreased to BL-values at the 12-week visit. EMMs ranged between 1.05 (95 %-CI: 1.04-1.06) and 1.08 (95 %-CI: 1.07-1.10). To conclude, combining stiffness results from two series of μFE-models obtained using single- and dual-threshold segmentation enables quantification of the contribution of lower-mineralized tissue to the stiffness of distal radius fractures during healing. This contribution is minor but changes significantly around the time of cast removal. Its course and timing during healing may be clinically relevant. Quantification of the contribution of lower-mineralized tissue to stiffness gives a more complete impression of strength recovery post-fracture than the evaluation of stiffness using a single series of μFE-models.
Collapse
Affiliation(s)
- Melissa S A M Bevers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Frans L Heyer
- NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Piet P M M Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Medicine and Life Sciences, Hasselt University, Belgium
| | | | | | - Martijn Poeze
- NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Surgery and Trauma Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joop P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands.
| |
Collapse
|
5
|
van Delft EAK, van Bruggen SGJ, van Stralen KJ, Bloemers FW, Sosef NL, Schep NWL, Vermeulen J. Four weeks versus six weeks of immobilization in a cast following closed reduction for displaced distal radial fractures in adult patients: a multicentre randomized controlled trial. Bone Joint J 2023; 105-B:993-999. [PMID: 37652443 DOI: 10.1302/0301-620x.105b9.bjj-2022-0976.r3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Aims There is no level I evidence dealing with the optimal period of immobilization for patients with a displaced distal radial fracture following closed reduction. A shorter period might lead to a better functional outcome due to less stiffness and pain. The aim of this study was to investigate whether this period could be safely reduced from six to four weeks. Methods This multicentre randomized controlled trial (RCT) included adult patients with a displaced distal radial fracture, who were randomized to be treated with immobilization in a cast for four or six weeks following closed reduction. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE) score after follow-up at one year. Secondary outcomes were the abbreviated version of the Disability of Arm, Shoulder and Hand (QuickDASH) score after one year, the functional outcome at six weeks, 12 weeks, and six months, range of motion (ROM), the level of pain after removal of the cast, and complications. Results A total of 100 patients (15 male, 85 female) were randomized, with 49 being treated with four weeks of immobilization in a cast. A total of 93 completed follow-up. The mean PRWE score after one year was 6.9 (SD 8.3) in the four-week group compared with 11.6 (SD 14.3) in the six-week group. However, this difference of -4.7 (95% confidence interval -9.29 to 0.14) was not clinically relevant as the minimal clinically important difference of 11.5 was not reached. There was no significant difference in the ROM, radiological outcome, level of pain, or complications. Conclusion In adult patients with a displaced and adequately reduced distal radial fracture, immobilization in a cast for four weeks is safe, and the results are similar to those after a period of immobilization of six weeks.
Collapse
Affiliation(s)
- Eva A K van Delft
- Department of Trauma Surgery, Amsterdam UMC, Amsterdam, Netherlands
- Department of Surgery, Spaarne Gasthuis Hospital, Haarlem, Netherlands
- Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, Netherlands
| | - Suus G J van Bruggen
- Department of Trauma Surgery, Amsterdam UMC, Amsterdam, Netherlands
- Department of Surgery, Spaarne Gasthuis Hospital, Haarlem, Netherlands
- Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Frank W Bloemers
- Department of Trauma Surgery, Amsterdam UMC, Amsterdam, Netherlands
| | - Nico L Sosef
- Department of Surgery, Spaarne Gasthuis Hospital, Haarlem, Netherlands
| | - Niels W L Schep
- Department of Trauma & Hand Surgery, Maasstad Hospital, Rotterdam, Netherlands
| | - Jefrey Vermeulen
- Department of Trauma & Hand Surgery, Maasstad Hospital, Rotterdam, Netherlands
| |
Collapse
|
6
|
Lucas B, Lippisch R, Pliske G, Piatek S, Walcher F. [Conservative management of distal radius fractures]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:227-237. [PMID: 36881137 DOI: 10.1007/s00113-023-01293-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 03/08/2023]
Abstract
Distal radius fractures are the third most frequent fractures in Germany. The decision for conservative treatment and the weighing up of surgical treatment need an exact consideration of the indications based on instability criteria and the extent of possible articular involvement. Indications for an emergency operation must be excluded. In cases of stable fractures or multimorbid patients in a poor general condition conservative treatment is indicated. The principles for a successful treatment are the precise reduction and stable retention in a plaster splint. In the further course, fractures are closely monitored by biplanar radiography. This is necessary to rule out a secondary displacement until the swelling of the soft tissues has subsided and the plaster splint is changed to a circular cast approximately 11 days after the traumatic event. The total duration of immobilization is 4 weeks. Physiotherapy and ergotherapy including adjacent joints, starts after 2 weeks of treatment. This treatment is extended to the wrist after removal of the circular cast.
Collapse
Affiliation(s)
- Benjamin Lucas
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland.
| | - Roland Lippisch
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Gerald Pliske
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Stefan Piatek
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Felix Walcher
- Universitätsklinik für Unfallchirurgie, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| |
Collapse
|
7
|
Khashab M, Alem A, Almuatiri A, Rasheed F, Almehmadi M, Felemabn S, Gassass S, Alosaimi M, Sulimani H, Alyami A. Comparison of the Effects of Regular Periods of Immobilization and Prolonged Immobilization on Hand Function Post Distal Radial Fracture. Cureus 2022; 14:e30986. [PMID: 36465201 PMCID: PMC9711891 DOI: 10.7759/cureus.30986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Distal radius fracture (DRF) is one of the most common orthopedic cases managed in the emergency room. DRF treatment is either non-operative or operative. Regardless of the treatment methodology, a period of immobilization of 4-6 weeks is required. Purpose The study aims to evaluate hand function for patients who sustained DRF with different immobilization periods in King Abdul-Aziz Medical City, National Guard Hospital - Jeddah (NGHA) from December 2016 until December 2019. Materials and methods This is a retrospective cohort study where we collected data of DRF patients managed in NGHA. Data was collected directly from NGHA medical records (December 2016-December 2019). A total of 44 patients met the inclusion criteria. Patients were divided into two groups; a group that was immobilized as per protocol (six weeks) and a group that deviated from protocol and immobilization exceeded six weeks. A data collection sheet included the patient's demographics, history, fracture description, management method, and hand function measurements. Results Of the 44 participants, 24 (54%) deviated from protocol; the remaining 20 (46%) were immobilized as per protocol. The prolonged immobilization group had limitations in hand function, restriction in extension (P-value = 0.641), and a decrease in grip strength (P-value = 0.291) compared to the per-protocol group. Flexion and radial deviation were affected similarly in both groups. Conclusion Although the results were not significant, immobilization for more than six weeks is associated with decreased hand function, range of motion (ROM), grip strength, and higher pain scores based on occupational therapy (OT) measurements.
Collapse
Affiliation(s)
- Mohammed Khashab
- Orthopaedic Surgery, King Abdulaziz Medical City/Ministry of National Guard - Health Affairs, Jeddah, SAU
| | - Ahmed Alem
- Orthopaedic Surgery, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | | | - Fatmah Rasheed
- Occupational Therapy, King Saud Bin Abdulaziz University, Jeddah, SAU
| | - Mai Almehmadi
- Health Sciences, King Saud Bin Abdulaziz University, Jeddah, SAU
| | - Shahad Felemabn
- Occupational Therapy, King Saud Bin Abdulaziz University, Jeddah, SAU
| | - Samah Gassass
- Occupational Therapy, King Saud Bin Abdulaziz University, Jeddah, SAU
| | - Majed Alosaimi
- Orthopaedic Surgery, King Abdulaziz Medical City/Ministry of National Guard - Health Affairs, Jeddah, SAU
- Orthopaedic Surgery, King Abdullah International Medical Research Center, Riyadh, SAU
- Orthopaedic Surgery, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Hani Sulimani
- Orthopaedics, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
- Orthopaedics, King Abdulaziz Medical City/Ministry of National Guard - Health Affairs, Jeddah, SAU
| | - Ali Alyami
- Surgery/Musculoskeletal Oncology, Limb Reconstructive Surgery, Sport Medicine and Arthroscopy, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Orthopaedics, King Abdulaziz Medical City/Ministry of National Guard - Health Affairs, Jeddah, SAU
| |
Collapse
|
8
|
Dadkhah-Tehrani M, Adib-Hajbaghery M, Abedi A. Frequency of cast-related complications and influencing factors in patients with casts. Int J Orthop Trauma Nurs 2022; 46:100955. [DOI: 10.1016/j.ijotn.2022.100955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022]
|
9
|
The Benefits and Harms of Early Mobilization and Supervised Exercise Therapy after Non-surgically Treated Proximal Humerus or Distal Radius fracture: A systematic Review and Meta-analysis. Curr Rev Musculoskelet Med 2021; 14:107-129. [PMID: 33689149 DOI: 10.1007/s12178-021-09697-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Fractures of the proximal humerus (PHF) and distal radius (DRF) are among the most common upper extremity fractures in the elderly. Recent randomized controlled trials support non-surgical treatment. Evidence behind the best non-surgical treatment strategy has been sparse and raises questions as to when and how to initiate exercises. The purpose of this systematic review and meta-analysis was to assess the benefits and harms of early mobilization versus late mobilization and supervised versus non-supervised exercises therapy after PHF and DRF. RECENT FINDINGS 15 published and 5 unpublished trials were included. Early mobilization after PHF resulted in better function with a mean difference (MD) of 4.55 (95% CI 0.00-9.10) on the Constant Shoulder Score. However, the MD was not found to be clinically relevant. No clear evidence showed that early mobilization after PHF had a positive effect on range of motion or pain. Neither did it lead to more complications. Furthermore, no eligible evidence was found supporting early mobilization to be superior to late mobilization after DRF, or that supervised exercise therapy was superior to non-supervised exercise therapy after PHF and DRF. The quality of evidence on all outcomes was found to be low or very low. Early mobilization after PHF may have a beneficial effect on function. Due to the lack of clear evidence, there is an urgent need for future studies to determine the effect of early mobilization and supervised exercise therapy after PHF and DRF. Prospero ID number: CRD42020167656, date of registration 28.04.2020.
Collapse
|
10
|
Luokkala T, Laitinen MK, Hevonkorpi TP, Raittio L, Mattila VM, Launonen AP. Distal radius fractures in the elderly population. EFORT Open Rev 2020; 5:361-370. [PMID: 32655892 PMCID: PMC7336190 DOI: 10.1302/2058-5241.5.190060] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We found no clear evidence of the clinical superiority of distal radius fracture surgery among older adults at one year. Surgical treatment, however, may yield a faster recovery to previous level of activity in elderly patients. With operative treatment, hardware-based problems may warrant secondary operations and implant removal, whereas in non-operative treatment, symptomatic loss of alignment and malunion can occur. In elderly patients, non-operative treatment can be considered to be the gold standard.
Cite this article: EFORT Open Rev 2020;5:361-370. DOI: 10.1302/2058-5241.5.190060
Collapse
Affiliation(s)
- Toni Luokkala
- Department of Orthopaedics, Central Finland Central Hospital, Jyväskylä, Finland
| | - Minna K Laitinen
- Department of Orthopaedics, Helsinki University Hospital, Helsinki, Finland
| | - Teemu P Hevonkorpi
- Department of Orthopaedics, Central Finland Central Hospital, Jyväskylä, Finland.,Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere, Finland
| | - Lauri Raittio
- Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere, Finland.,Department of Orthopaedics and Traumatology, Tampere University Hospital, Finland
| | - Antti P Launonen
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Finland
| |
Collapse
|
11
|
Delft EAV, Gelder TGV, Vries RD, Vermeulen J, Bloemers FW. Duration of Cast Immobilization in Distal Radial Fractures: A Systematic Review. J Wrist Surg 2019; 8:430-438. [PMID: 31579555 PMCID: PMC6773589 DOI: 10.1055/s-0039-1683433] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/28/2019] [Indexed: 01/07/2023]
Abstract
Objective The duration of immobilization in distal radial fractures is disputed in the current literature. There are still no long-term superior outcomes of operative treatment in comparison to nonoperative treatment. A systematic review was initiated to assess the clinical controversy on the duration of the immobilization period for nonoperatively treated distal radial fractures. Materials and Methods A comprehensive search was performed in the PubMed, Embase, and Wiley/Cochrane Library databases and a manual reference check of the identified systematic reviews and meta-analyses was executed. Eligible studies were randomized controlled trials that compared two periods of immobilization, with reported functional, patient-reported, and radiological outcomes. Two reviewers independently agreed on eligibility, and assessed methodological quality and extracted outcome data. Results The initial search yielded 3.384 studies. Twelve trials, with 1063 patients, were included in this systematic review. Grip strength and patient-reported outcome were better in patients treated by a shorter period of immobilization. There was no difference in pain, range of motion, or radiological outcome between different periods of immobilization. Owing to heterogeneity of studies, data were unsuitable for pooling. Conclusion Included studies showed that there might be a preference for a shorter period of immobilization in nonoperatively treated distal radius fractures. Therefore, shortening the period of immobilization in distal radial fractures to a maximum of three weeks should be considered. Future research should include homogeneous groups of patients to draw valid conclusions on the appropriate period of immobilization for nonoperatively treated distal radial fractures. Level of Evidence This is a Level II study. Systematic Review Registration Number PROSPERO 2018 CRD42018085524.
Collapse
Affiliation(s)
- Eva A.K. van Delft
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Tamara G. van Gelder
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jefrey Vermeulen
- Department of Trauma Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Frank W. Bloemers
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|