If there is visible deformity and pain, it is reasonable not to assess the fracture site itself any further. Injury, or is the skin threatened? If the skin over the fracture is severelyĬontused, stretched over the fracture, ischaemic (white) or necrotic (darkīlue/black) then there is a risk of a closed fracture becoming open. Take a full past medical, social (including hand dominanceĪssess the skin over the fracture site. Remember that a painful wrist is a distracting injury, and patients may neglect to mention other important injuries, especially the hip (older patients) or head and spine.Īsk about neurovascular symptoms in the hand: Important not to miss a life-threatening other injury – consider ATLS primaryĭocument the mechanism and any other painful areas. Initial assessmentĪs always, these may be high-energy injuries, and it is Patients present with a combination of pain in the wrist/distal radius, deformity and loss of range of movement. The most common mechanism for a distal radius fracture is a fall on out-stretched hand (FOOSH). Most can be safely managed non-operatively and without hospital admission, but there are important exceptions. We hope to create a specific article on corresponding paediatric injuries.Īs with all orthopaedic trauma, distal radius fractures may be high- or low-energy. This page is specifically regarding adult injuries. Studies a U.S.Reducing fractures in the emergency departmentĪdmission, discharge and calling a senior Hardcopy data will be stored in a locked cabinets in the office of the principal investigator and accessed only by the principal investigator, co-investigators or study administrators.Electronic records will be kept on an encrypted hard drive.Records for all participants, including all source documentation (containing evidence to study eligibility, history and physical findings, results of consultations etc) as well as IRB records and other regulatory documentation will be retained by the principal investigator via the following means: Individual Participant Data (IPD) Sharing Statement: Both intention-to-treat and per-protocol analyses will be performed.Ī Randomized Controlled Trial Comparing Clinical Outcomes of Casting Versus Splinting in Distal Radius Fractures in Patients 60 Years and Above A non-inferiority design was selected because it is unlikely that splints are superior to casts with regards to the primary outcome - final functional outcome at 12 months. The study methodology will be a non-inferiority randomized controlled trial (RCT). Top of Page Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information This is consistent with our aim to improve patients' overall quality of life after musculoskeletal injuries and forms a core component of functional ageing. Second, patients may not be required to present for long (>6-month) follow-ups if it can be shown that the clinical improvement plateaus at 6 months after injury. First, patients may be encouraged to use splints instead of casts if there is no difference in functional outcome and the former provide better comfort. This study is clinically important for several reasons. The secondary goals are to demonstrate: (1) splinting results in greater patient comfort and acceptance (2) there is no significant difference in final radiographic outcomes between DRF treated with casts and splints and (3) there is no difference in clinical outcome at the 6-month and 12-month follow-up points. The primary goal of this study is to show that there is no difference in the final functional outcome between distal radius fractures treated non-operatively with splints and casts. they tolerated a large degree of fracture malunion (Arora Egol). Moreover, it has been clearly shown that the elderly patients have good functional outcomes that do not correlate with the position in which the fracture heals i.e. However, it is known that fractures displace even in casts and the efficacy of casts at maintaining reduction over splints has not been established. Splints are theoretically less rigid and patient non-compliance because of the ease of removal may result in a greater likelihood of fracture displacement. Splints have the advantage of being removable and therefore facilitate hygiene and provide a better fit because of the adjustable straps. Casts require specialized tools for removal and they have to be reapplied by specialized staff if the casts become loose or wet. Casts have been traditionally the gold standard for non-operative care of fractures, but there are distinct disadvantages such as skin rash and pruritus, malodour, skin maceration and loosening as the initial swelling subsides. Why Should I Register and Submit Results?Ĭasts and splints are both established methods of treating DRF.
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