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Barvelink B, Reijman M, Smidt S, Miranda Afonso P, Verhaar JAN, Colaris JW, van Beek F, Bouwhuis MG, Bruijninckx MMM, Greeven APA, Gosens T, Kok MJ, Kokke MC, Kraan GA, van Lakwijk K, Leijnen M, van Loon M, van Rijssel DA, Schep NWL, Scholtens L, Wijffels MME, Slebioda N, van der Zwaal P, Zwets E. Redisplacement of reduced distal radius fractures in adults: does the type of casting play a role? The CAST study, a multicentre cluster randomized controlled trial. Bone Joint J 2024; 106-B:696-704. [PMID: 38945541 DOI: 10.1302/0301-620x.106b7.bjj-2024-0014.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
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.
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Affiliation(s)
- Britt Barvelink
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Max Reijman
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sanne Smidt
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Pedro Miranda Afonso
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Joost W Colaris
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Flip van Beek
- Department of Trauma Surgery, Franciscus Hospital, Schiedam and Rotterdam, Rotterdam, Netherlands
| | - Marna G Bouwhuis
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Milko M M Bruijninckx
- Department of Trauma Surgery, IJsselland Hospital, Capelle aan den IJssel, Netherlands
| | | | - Taco Gosens
- Department of Orthopaedic Surgery, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands
| | - Mirte J Kok
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marike C Kokke
- Department of Trauma Surgery, St. Antonius Hospital, Utrecht and Nieuwegein, Utrecht, Netherlands
| | - Gerald A Kraan
- Department of Orthopaedic Surgery, Reinier de Graaf Gasthuis, Delft, Netherlands
| | - Kevin van Lakwijk
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Michiel Leijnen
- Department of Trauma Surgery, Alrijne Hospital, Leiderdorp, Netherlands
| | - Merel van Loon
- Department of Emergency Medicine, Haaglanden Medical Center, The Hague, Netherlands
| | | | - Niels W L Schep
- Department of Trauma Surgery, Maasstad Hospital, Rotterdam, Netherlands
| | - Lenneke Scholtens
- Department of Emergency Medicine, Haga Hospital, The Hague, Netherlands
| | - Mathieu M E Wijffels
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Ninka Slebioda
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Peer van der Zwaal
- Department of Orthopaedic Surgery, Haaglanden Medical Center, the Hague, Netherlands
| | - Egon Zwets
- Department of Emergency Medicine, Franciscus Hospital, Schiedam and Rotterdam, Rotterdam, Netherlands
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Xiao YP, Xu HJ, Liao W, Li ZH. Clinical application of instant 3D printed cast versus polymer orthosis in the treatment of colles fracture: a randomized controlled trial. BMC Musculoskelet Disord 2024; 25:104. [PMID: 38297262 PMCID: PMC10829219 DOI: 10.1186/s12891-024-07212-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The shortcomings of plaster in water resistance, air permeability, skin comfort, fixed stability and weight of wearing are still to be solved. 3D printed cast can overcome the above shortcomings. At present, there is a relative lack of data on the clinical application of 3D printed cast, probably due to its complexity, relatively long operating time, and high price. We aimed to compare and evaluate the short-term effectiveness, safety and advantages of 3D printed wrist cast versus polymer orthosis in the treatment of Colles fracture. METHODS Forty patients with Colles fracture in our hospital from June to December 2022 were selected and divided into an observation group (20 patients, treated with instant 3D printed cast) and a control group (20 cases, treated with polymer orthosis). Both groups treated with manual reduction and external fixation. The visual analogue scale (VAS), immobilization effectiveness and satisfaction scores, Disability of the Arm, Shoulder and Hand (DASH) score, complications and imaging data were collected and compared before immobilization and at 2, 6 and 12 weeks after the fracture. RESULTS VAS at 2 weeks after the fracture was significantly lower in the observation group than in the control group ( P < 0.05). The immobilization effectiveness and satisfaction scores at 6 weeks after the fracture were significantly higher in the observation group than in the control group (all P < 0.05). The DASH scores at 2 and 6 weeks after the fracture were significantly lower in the observation group than in the control group (all P < 0.05). There wasn't rupture of the printed cast or orthosis in both groups. There were 2 cases of skin irritation in the control group, and no skin irritation occurred in the observation group. The palmar tilt angle and ulnar inclination angle at 2 weeks and 12 weeks after the fracture were significantly higher in the observation group than in the control group (all P < 0.05). CONCLUSIONS Both instant 3D printed cast and polymer orthosis are effective in the treatment of Colles fracture. But instant 3D printed cast is better than polymer orthosis in areas of good clinical and imaging performance, and high patient satisfaction and comfort.
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Affiliation(s)
- Ya-Ping Xiao
- The Department of Orthopedic Surgery, Wuhan Third Hospital, Tongren Hospital of Wuhan University, No. 241, Pengliuyang Road, Wuhan, 430000, Hubei Province, P.R. China
| | - Hai-Jia Xu
- The Department of Orthopedic Surgery, Wuhan Third Hospital, Tongren Hospital of Wuhan University, No. 241, Pengliuyang Road, Wuhan, 430000, Hubei Province, P.R. China
| | - Wen Liao
- The Department of Orthopedic Surgery, Wuhan Third Hospital, Tongren Hospital of Wuhan University, No. 241, Pengliuyang Road, Wuhan, 430000, Hubei Province, P.R. China
| | - Zhang-Hua Li
- The Department of Orthopedic Surgery, Wuhan Third Hospital, Tongren Hospital of Wuhan University, No. 241, Pengliuyang Road, Wuhan, 430000, Hubei Province, P.R. China.
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