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.

Autor:	Barvelink B; Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Reijman M; Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Smidt S; Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Miranda Afonso P; Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Verhaar JAN; Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Colaris JW; Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., van Beek F; Department of Trauma Surgery, Franciscus Hospital, Schiedam and Rotterdam, Rotterdam, Netherlands., Bouwhuis MG; Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Bruijninckx MMM; Department of Trauma Surgery, IJsselland Hospital, Capelle aan den IJssel, Netherlands., Greeven APA; Department of Trauma Surgery, Haga Teaching Hospital, The Hague, Netherlands., Gosens T; Department of Orthopaedic Surgery, Elisabeth-Tweesteden Hospital, Tilburg, Netherlands., Kok MJ; Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Kokke MC; Department of Trauma Surgery, St. Antonius Hospital, Utrecht and Nieuwegein, Utrecht, Netherlands., Kraan GA; Department of Orthopaedic Surgery, Reinier de Graaf Gasthuis, Delft, Netherlands., van Lakwijk K; Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., Leijnen M; Department of Trauma Surgery, Alrijne Hospital, Leiderdorp, Netherlands., van Loon M; Department of Emergency Medicine, Haaglanden Medical Center, The Hague, Netherlands., van Rijssel DA; Department of Emergency Medicine, Reinier de Graaf Gasthuis, Delft, Netherlands., Schep NWL; Department of Trauma Surgery, Maasstad Hospital, Rotterdam, Netherlands., Scholtens L; Department of Emergency Medicine, Haga Hospital, The Hague, Netherlands., Wijffels MME; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, Netherlands., Slebioda N; Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands., van der Zwaal P; Department of Orthopaedic Surgery, Haaglanden Medical Center, the Hague, Netherlands., Zwets E; Department of Emergency Medicine, Franciscus Hospital, Schiedam and Rotterdam, Rotterdam, Netherlands.
Jazyk:	angličtina
Zdroj:	The bone & joint journal [Bone Joint J] 2024 Jul 01; Vol. 106-B (7), pp. 696-704. Date of Electronic Publication: 2024 Jul 01.
DOI:	10.1302/0301-620X.106B7.BJJ-2024-0014.R1
Abstrakt:	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. Competing Interests: None declared. (© 2024 Barvelink et al.)
Databáze:	MEDLINE
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