A Novel Splint Technique for Distal Radius Treatment
Condition: Distal Radius Fracture; Complication of Treatment
MeSH terms: Fractures, Bone; Radius Fractures; Wrist Fractures
Study type: Interventional

Summary: 
      There are many conservative treatment methods, including below arm cast, above arm cast, and
      sugar tong splint that aim to obtain maximum functional, clinical, and radiological results
      There are no clear indications with regard to the best treatment including conservative or
      surgical methods for the different fracture subtypes in distal radius fracture. The purpose
      of this prospective randomized study was to compare a new reverse sugar tong splint technique
      that does not immobilize the elbow with a below-arm cast, in terms of patient radiological
      and clinical outcomes and the ability to maintain fracture reduction.
    

Detailed description: 
      This study was conducted at a single Orthopedics and Traumatology emergency department center
      between April 2017 and March 2019. A two-arm, parallel-group, prospective randomized trial
      was conducted to compare below-arm cast (BAC) and reverse sugar tong (RST) (described below)
      treatment of DRF.

      Overall, 231 patients diagnosed with distal radius fracture in the emergency department
      received prospective treatment.

      Inclusion criteria: Patients aged >18 years and with distal radius fracture type A and B (who
      presented within 10 days of the injury) were considered for inclusion.

      Exclusion criteria: Patients with AO type C distal radius fractures (treated surgically),
      type 2 and 3 open fractures (according to Gustilo classification), previous hand or wrist
      surgery, fractures in the concomitant side of the upper extremities, associate carpal
      fracture, deformity on same extremity, pathological fractures, and cognitive deficit that
      does not allow the patient to understand the functional evaluation were excluded from this
      study. Lastly, patients who did not return for a follow-up visit at the end of the cast or
      splint treatment were also excluded.

      Patient selection and treatment methods Sample Size: The sample size was calculated based on
      a 15-20% difference in complication rate between the two treatment groups, an alpha level of
      5% and a power of 80%. Consequently, each group shall at least consist of 55 participants. We
      considered an extra 20% who loss of follow-up or loss of reduction and surgery may require
      for balancing sample size. With expectation of dropouts70 patients per group were included.

      All the initial fractures of the patients were classified by the same author using the AO
      classification. Patients were randomly allocated to a treatment group using an electronic
      random number generator, with those having an even number assigned to the BAC group and those
      having an odd number to the RST group. Treatment in both the BAC and RST groups was conducted
      by the same investigator. The reduction obtained was checked on AP and lateral x-ray of the
      wrist, which were then used to calculate the following baseline radiological parameters:
      radial inclination (RI), radial height (RH), and volar tilt (VT).

      Follow-up Management Clinical and radiological follow-up was performed 7-10 days (initial
      follow-up), three weeks, 5 or 6 weeks, 12 weeks and one year (last follow-up) after the
      treatment. X-rays at the initial follow-up which was performed 7-10 days after the initial
      closed reduction were taken with the cast or splint in place. Maintenance of fracture
      reduction was defined as a loss of reduction of less than 2 mm of radial height, 5° of radial
      inclination or 10° of volar tilt from the initial reduction films, and/or less than 2 mm of
      intra-articular step-off. In the initial follow-up, third week, and 6th week visit, patients
      were evaluated with x-ray to detect cast and splint complications, including those that
      require cast wedging or valving to reduce the pressure and the presence of complex regional
      pain syndrome (CRPS). Both treatments were removed during the 5-6th week visit in all groups.

      Functional outcomes The validated quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH)
      questionnaire score and the Mayo Elbow Performance score (MEPS) score were used to measure
      clinical outcomes.These scores were performed at the12th week and last follow-up visit for
      all the patients. Both groups were also evaluated with the Health Assessment Questionnaire
      (HAQ) at the 6th week visit for health status.

      Radiological evaluation All the radiological parameters were measured by the same author at
      two time points: initial visit postreduction and 6th visit after the end of treatment. Radial
      height, Radial inclination and Volar tilt were measured separetly.

      Clinical evaluations The wrist range of motion was measured in degree, using a goniometer,
      from the neutral position to flexion, extension, radial deviation, and ulnar deviation by
      same investigator during the last follow-up visit. The forearm rotation was also measured.
    

Intervention name(s): Conservative Treatment of Distal Radius Fracture
Intervention type(s): Procedure
Intervention description(s): The purpose of this prospective randomized study was to compare a new reverse sugar tong splint technique that does not immobilize the elbow with a below-arm cast, in terms of patient radiological and clinical outcomes and the ability to maintain fracture reduction.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: distal radius fracture; conservative treatment; reverse sugar tong; below arm cast