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Saturday, March 3, 2001

Role of above-elbow immobilization of fractures questioned

Above-elbow immobilization is often recommended in the closed treatment of unstable distal radius fractures despite a lack of supporting evidence. The study presented Thursday in scientific paper 142 prospectively investigates risk factors for distal radius fracture displacement during closed treatment and compares the effectiveness of short- and long-arm casts at preventing this collapse.

The conclusion of the investigators is that the study data question the role of above-elbow immobilization in the closed treatment of stable or unstable distal radius fractures.

Over two years, 127 adult patients with acute, closed, distal radius fractures were randomized to short or long-arm (neutral forearm rotation) casts after closed reduction. The patients were followed radiographically until fracture healing (mean: 41 days) with interval radiographs taken at means of 6 and 15 days.

Volar tilt, radial inclination, and radial length were measured at each time point by a blinded observer. The fractures were classified according to the systems of Fryckman, AO, and Fernandez by a second blinded observer.

The mean change in each radiographic parameter at each time point was calculated. Multiple regression analysis showed no significant difference between short- and long-arm casts in maintenance of volar tilt, radial inclination, or radial length, while controlling for age, gender, initial displacement, and fracture classification (p > 0.05, power > 0.80). Fryckman type VIII, Fernandez type III, and initial dorsal tilt > 5 degrees were found as independent risk factors for displacement during immobilization (p < 0.05).

Within each of these subgroups of unstable fractures, multiple regression again showed no benefit to long-arm casts (p > 0.05, power > 0.80).

The investigators are Roger Cornwall, MD; Richard F. Ghillani, MD; and Judith Levine, MD, all of the department of orthopaedics, Mt. Sinai School of Medicine, Elmhurst Hospital center, New York, N.Y.

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2001 Academy News March 3 Index C

Last modified 16/February/2001 by IS