Rigid Immobilization for Displaced Fractures
We suggest rigid immobilization in preference to removable splints when using non-operative treatment for the management of displaced distal radius fractures.
Rationale
For the purposes of this recommendation we considered rigid immobilization to be any form of immobilization that was firm (e.g. plaster, fiberglass) and not intended for self-removal, and less-rigid immobilization was any type of wrap or brace that either incompletely immobilized the wrist or was intended to be removed by the patient.
Five Level II randomized controlled trials met the inclusion criteria.47-51 There were significant differences in pain at 5-6, 8 and 24 weeks in favor of casting. All other durations of follow-up did not have significant differences between patients treated with rigid immobilization or less-rigid immobilization. Radial nerve symptoms occurred more often in patients treated with less-rigid immobilization and no other complications were significantly different.
Five Level II randomized controlled trials met the inclusion criteria.47-51 There were significant differences in pain at 5-6, 8 and 24 weeks in favor of casting. All other durations of follow-up did not have significant differences between patients treated with rigid immobilization or less-rigid immobilization. Radial nerve symptoms occurred more often in patients treated with less-rigid immobilization and no other complications were significantly different.
- (47) Tumia N, Wardlaw D, Hallett J, Deutman R, Mattsson SA, Sanden B. Aberdeen Colles' fracture brace as a treatment for Colles' fracture. A multicentre, prospective, randomised, controlled trial. J Bone Joint Surg Br 2003;85(1):78-82.
- (48) Moir JS, Murali SR, Ashcroft GP, Wardlaw D, Matheson AB. A new functional brace for the treatment of Colles' fractures. Injury 1995;26(9):587-593.
- (49) Ledingham WM, Wytch R, Goring CC, Mathieson AB, Wardlaw D. On immediate functional bracing of Colles' fracture. Injury 1991;22(3):197-201.
- (50) Bunger C, Solund K, Rasmussen P. Early results after Colles' fracture: functional bracing in supination vs dorsal plaster immobilization. Arch Orthop Trauma Surg 1984;103(4):251-256.
- (51) Stewart HD, Innes AR, Burke FD. Functional cast-bracing for Colles' fractures. A comparison between cast-bracing and conventional plaster casts. J Bone Joint Surg Br 1984;66(5):749-753.