Dataset Information

Efficacy of cast immobilization versus surgical treatment for distal radius fractures in adults: a systematic review and meta-analysis.

ABSTRACT: This articl e includes high-quality randomized controlled trials in recent years and updates the past meta-analysis. It has been proved that cast immobilization can achieve similar functional results, reduce economic burden in the long-term compared with surgery, and provide a basis for doctors to make treatment choices.

Purpose

The efficacy of conservative and surgical treatment of distal radius fractures (DRFs) in adults is still controversial. Recently, some high-quality randomized controlled trials (RCTs) evaluated the efficacy of both treatments. We hypothesized that treatment of DRFs with closed reduction and cast immobilization would achieve functional outcomes similar to surgery.

Methods

This study is a systematic review and summary of RCTs comparing conservative and surgical management of DRFs from 2005 to March 2022. Patients were evaluated for functional and imaging outcomes and complications.

Results

A total of 11 studies [1-11] included 1775 cases of DRFs. At 1-year follow-up, the cast group had lower mean differences (MDs) in DASH scores than the surgery group by - 2.55 (95% CI = - 5.02 to - 0.09, P = 0.04); with an MD of 1.63 (95% CI = 1.08-2.45, P = 0.02), while the surgery group had a lesser complication rate than the cast group.

Conclusions

At 1-year follow-up, the lower DASH scores of the cast group showed advantages of this treatment, but the complication rate was higher than that of the surgery group. There was no massive distinction in other scoring methods.

SUBMITTER: Yang Q

PROVIDER: S-EPMC10050022 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

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Publications

Efficacy of cast immobilization versus surgical treatment for distal radius fractures in adults: a systematic review and meta-analysis.

Yang Qifan Q Cai Guoyong G Liu Jing J Wang Xinyu X Zhu Dong D

Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 20221220 4

This articl e includes high-quality randomized controlled trials in recent years and updates the past meta-analysis. It has been proved that cast immobilization can achieve similar functional results, reduce economic burden in the long-term compared with surgery, and provide a basis for doctors to make treatment choices.<h4>Purpose</h4>The efficacy of conservative and surgical treatment of distal radius fractures (DRFs) in adults is still controversial. Recently, some high-quality randomized con ...[more]

PMID: 36538053

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Project description:IntroductionThe aim of this systematic review and meta-analysis was to evaluate whether volar locking plate (VLP) fixation leads to better clinical and radiological outcomes than those of closed reduction and cast immobilization for the treatment of distal radius fractures (DRFs).Materials and methodsA comprehensive literature search was performed in PubMed, Web of Science, and Cochrane databases up to January 2022. Inclusion criteria included randomized controlled trial (RCT) studies comparing VLP fixation with cast immobilization for DRFs. Investigated parameters were Patient-Rated Wrist Evaluation questionnaire, Disabilities of the Harm, Shoulder, and Hand score (DASH), range of motion (ROM), grip strength, quality of life (QoL), radiological outcome, and complication and reoperation rate, both at short- and mid-/long-term follow-up. Assessment of risk of bias and quality of evidence was performed with Downs and Black's 'Checklist for Measuring Quality'.ResultsA total of 12 RCTs (1368 patients) were included. No difference was found for ROM, grip strength, QoL, and reoperation, while the DASH at 3 months was statistically better in the VLP group (P < 0.05). No clinical differences were confirmed at longer follow-up. From a radiological perspective, only radial inclination (4°) and ulnar variance (mean difference 1.1 mm) at >3 months reached statistical significance in favor of the VLP group (both P < 0.05). Fewer complications were found in the VLP group (P < 0.05), but they did not result in different reintervention rates.ConclusionsThis meta-analysis showed that the surgical approach leads to a better clinical outcome in the first months, better fracture alignment, and lower complication rate. However, no differences in the clinical outcomes have been confirmed after 3 months. Overall, these findings suggest operative treatment for people with higher functional demand requiring a faster recovery, while they support the benefit of a more conservative approach in less demanding patients.

Project description:PurposeDisplaced distal radius fractures in children are common and often treated by reduction and cast immobilization. Redisplacement occurs frequently and may be prevented by additional treatment with K-wire fixation after initial reduction. This meta-analysis aims to summarize available literature on this topic and determine if primary K-wire fixation is the preferred treatment for displaced distal radius fractures in children.MethodsA search in eight databases identified studies that compared cast immobilization alone to additional K-wire fixation as treatment for displaced paediatric distal radius fractures. The primary outcome was the redisplacement rate. Secondary outcomes were secondary reduction rate, range of motion and complications. This meta-analysis was performed according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement.ResultsThree RCTs and 3 cohort studies, analysing 197 patients treated with cast immobilization alone and 185 with additional K-wire fixation, were included in this meta-analysis. Redisplacement occurred less frequently after additional K-wire fixation than after cast alone (3.8 versus 45.7%; OR 0.07, 95% CI 0.03-0.15). Secondary reduction was performed in 59.8% of the redisplaced fractures. Complications, other than redisplacement, occurred more often after additional K-wire fixation than after cast alone (15.7 versus 3.6%). Range of motion did not differ after both treatments.ConclusionsAdditional K-wire fixation is a suitable treatment to prevent redisplacement and secondary operations after initial reduction of displaced distal radius fractures in children, but is associated with post-procedural complications. Additional K-wire fixation does not result in a better range of motion than cast immobilization alone. More research is needed to identify those patients who will benefit the most from K-wire fixation as a treatment for displaced distal radius fractures in children.

Project description:BackgroundAn effective and appropriate method to support the ankle joint optimally is particularly important during the healing phase of ankle fractures. The purpose of this review was to assess the functional outcomes, ankle-related quality of life, and associated complications of cast immobilization versus removable braces for the treatment of adult ankle fractures.MethodsStudies comparing cast immobilization and removable braces after ankle fracture were included by systematic searches of PubMed/MEDLINE, Web of Science, Scopus, and EMBASE databases according to PRISMA (Preferred Reporting Items for Systematic Evaluation and Meta-Analysis Statements) guidelines. Primary outcome measures included early to mid-late Olerud Molander Ankle Score (OMAS). Secondary outcomes were ankle dorsiflexion and plantarflexion, swelling, pain, time to return to work, calf muscle atrophy, and complications. Subgroup analysis was performed. Risk of bias was assessed in both randomized controlled trials and cohort studies.ResultsEleven studies including 1485 patients met the eligibility criteria. The fracture types of the study included Weber A/B/C and Lauge-Hansen supination external rotation (SER), supination-adduction (SA), pronation-external rotation (PER) and pronation-abduction (PA). The results of the meta-analysis showed that removable braces had better early (mean difference (MD) -2.14; 95% confidence interval (CI) -4.26, 0.00) and mid-term functional outcomes (MD -5.81; 95% CI -10.35, -1.27) after ankle fracture compared with cast immobilization. In addition, removable braces caused significantly more wound breakdown (Odds ratio (OR) 0.39; 95% CI 0.17, 0.90) and wound infections (OR 0.32; 95% CI 0.17, 0.58) than cast immobilization.ConclusionCompared with cast immobilization, removable braces had better functional outcomes in the early and mid-term periods after ankle fractures and were less likely to result in deep vein thrombosis (DVT). Overall, the removable brace is a comfortable ankle fracture option that might improve functional outcomes.

Dataset Information

Efficacy of cast immobilization versus surgical treatment for distal radius fractures in adults: a systematic review and meta-analysis.

Purpose

Methods

Results

Conclusions

Publications

Efficacy of cast immobilization versus surgical treatment for distal radius fractures in adults: a systematic review and meta-analysis.

Similar Datasets

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