Differences in Inflammation, Radiological and Clinical Outcomes between Short Arm Cast and Long Arm Cast in Intraarticular Distal Radius Fractures

Made Asmara  Yoga; Ketut Siki  Kawiyana; Made Bramantya Karna

doi:10.3889/oamjms.2023.11624

Authors

Made Asmara Yoga Department of Orthopedic and Traumatology, Faculty of Medicine, Udayana University, RSUP, Sanglah General Hospital, Denpasar, Bali, Indonesia
Ketut Siki Kawiyana Department of Orthopedic and Traumatology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia
Made Bramantya Karna Department of Orthopedic and Traumatology, Faculty of Medicine, Udayana University, Sanglah General Hospital, Denpasar, Bali, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2023.11624

Keywords:

intraarticular distal radius fracture, long arm cast, short arm cast, interleukin-6, ulnar variance, dorsal tilt, articular step-off, RUSS score, PRWE score

Abstract

BACKGROUND: Distal radius fractures are the most common upper extremity fractures with a prevalence of 20% of all limb fractures. According to the distal radius fracture guidelines by the American Academy of orthopedic surgeons, conservative therapy can be used in the management of distal radius fractures that are well reduced.

AIM: The purpose of this study was to compare conservative therapy of short arm cast (SAC) and long arm cast (LAC) in the management of intraarticular distal radius fractures.

METHODS: A prospective cohort observational study with consecutive sampling was conducted on 24 intraarticular distal fracture patients who underwent SAC and LAC procedures. The parameters measured were Interleukin-6 (IL-6) score, ulnar variance (UV), dorsal tilt (DT), articular step-off (SO), radiological union score system (RUSS), and patient-rated wrist evaluation (PRWE) score.

RESULTS: The dominance of patients was males aged 46 years, with an average IL-6 levels at 0–24 was 1139.23 ± 266.82 SAC and 1082.64 ± 255.85 LAC, and IL-6 levels at 48 h was 102.98 ± 39.31 SAC and 118.38 ± 39.15 LAC; 2 patients with SAC and 1 patient with LAC obtained unacceptable reduction at week 2 based on UV, DT, SO which did not differ significantly from each follow-up; RUSS 6.08 ± 0.76 SAC and 5.71 ± 0.61 LAC; and PRWE 73.23 ± 4.42 SAC and 71.86 ± 4.07 LAC. Based on statistical analysis, there were insignificant differences in IL-6, UV, DT, SO, RUSS, and PRWE levels between the SAC and LAC groups (p > 0.05).

CONCLUSION: Conservative therapy with SAC may be an option for immobilization of distal radius fracture similar to LAC.

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References

Kachooei AR, Peivandi MT, Ebrahimzadeh MH, Razi S, Naghashzargar RM, Noori M, et al. Outcome assessment in the treatment of A2-OTA type fractures of the distal radius by short arm cast versus long arm cast. Ann Biol Res. 2013;4(5):247-51.

Kim JK, Park ES. The effect of short arm cast length on forearm rotation. J Hand Surg Am. 2014;39(4):629-33. https://doi.org/10.1016/j.jhsa.2013.12.034 PMid:24559756 DOI: https://doi.org/10.1016/j.jhsa.2013.12.034

Aparicio P, Izquierdo Ó, Castellanos J. Conservative treatment of distal radius fractures: A prospective descriptive study. Hand (N Y). 2018;13(4):448-54. https://doi.org/10.1177/1558944717708025 PMid:28581340 DOI: https://doi.org/10.1177/1558944717708025

Jung HW, Hong H, Jung HJ, Kim JS, Park HY, Bae KH, et al. Redisplacement of distal radius fracture after initial closed reduction: Analysis of prognostic factors. Clin Orthop Surg. 2015;7(3):377-82. https://doi.org/10.4055/cios.2015.7.3.377 PMid:26330962 DOI: https://doi.org/10.4055/cios.2015.7.3.377

Lichtman DM, Bindra RR, Boyer MM, Putnam MD, Ring D, Slutsky DJ, et al. Treatment of distal radius fractures. J Am Acad Orthop Surg. 2010;18(3):180-9. https://doi.org/10.5435/00124635-201003000-00007 PMid:20190108 DOI: https://doi.org/10.5435/00124635-201003000-00007

Dib G, Maluta T, Cengarle M, Bernasconi A, Marconato G, Corain M, et al. Short arm cast is as effective as long arm cast in maintaining distal radius fracture reduction: Results of the SLA-VER noninferiority trial. World J Orthop. 2022;13(9):802-11. https://doi.org/10.5312/wjo.v13.i9.802 PMid:36189333 DOI: https://doi.org/10.5312/wjo.v13.i9.802

Obert L, Loisel F, Jardin E, Gasse N, Lepage D. High-energy injuries of the wrist. Orthop Traumatol Surg Res. 2016;102(1 suppl):S81-93. https://doi.org/10.1016/j.otsr.2015.05.009 PMid:26782706 DOI: https://doi.org/10.1016/j.otsr.2015.05.009

Putra IG, Kawiyana IK, Dusak IW, Astawa P, Suyasa IK, Ridia KG, et al. Patient Rated Wrist Examination (PRWE) and Radius Union Scoring System (RUSS) scores are better by administering Platelet Rich Plasma in cases of distal radius fracture with treatment therapy. Intisari Sains Med. 2020;11:1108-12. https://doi.org/10.15562/ism.v11i3.776 DOI: https://doi.org/10.15562/ism.v11i3.776

Smith JK. IL-6 and the dysregulation of immune, bone, muscle, and metabolic homeostasis during spaceflight. NPJ Microgravity.

;4:24. https://doi.org/10.1038/s41526-018-0057-9 PMid:30534586 DOI: https://doi.org/10.1038/s41526-018-0057-9

Maruyama M, Rhee C, Utsunomiya T, Zhang N, Ueno M, Yao Z, et al. Modulation of the inflammatory response and bone healing. Front Endocrinol (Lausanne). 202011:386. https://doi.org/10.3389/fendo.2020.00386 PMid:32655495 DOI: https://doi.org/10.3389/fendo.2020.00386

Kaiser K, Prystaz K, Vikman A, Haffner-Luntzer M, Bergdolt S, Strauss G, et al. Pharmacological inhibition of IL-6 trans-signaling improves compromised fracture healing after severe trauma. Naunyn Schmiedebergs Arch Pharmacol. 2018;391(5):523-36. https://doi.org/10.1007/s00210-018-1483-7 PMid:29497762 DOI: https://doi.org/10.1007/s00210-018-1483-7

Boyd AS, Benjamin HJ, Asplund C. Splints and casts: Indications and methods. Am Fam Physician. 2009;80(5):491-9. PMid:19725490

Lameijer CM, Ten Duis HJ, Vroling D, Hartlief MT, El Moumni M, van der Sluis CK. Prevalence of posttraumatic arthritis following distal radius fractures in non-osteoporotic patients and the association with radiological measurements, clinician and patient-reported outcomes. Arch Orthop Trauma Surg. 2018;138(12):1699-712. https://doi.org/10.1007/s00402-018-3046-2 PMid:30317380 DOI: https://doi.org/10.1007/s00402-018-3046-2

Caruso G, Tonon F, Gildone A, Andreotti M, Altavilla R, Valentini A, et al. Below-elbow or above-elbow cast for conservative treatment of extra-articular distal radius fractures with dorsal displacement: A prospective randomized trial. J Orthop Surg Res. 2019;14(1):477. https://doi.org/10.1186/s13018-019-1530-1 PMid:31888682 DOI: https://doi.org/10.1186/s13018-019-1530-1

Okamura A, de Moraes VY, Neto JR, Tamaoki MJ, Faloppa F, Belloti JC. No benefit for elbow blocking on conservative treatment of distal radius fractures: A 6-month randomized controlled trial. PLoS One. 2021;16(6):e0252667. https://doi.org/10.1371/journal.pone.0252667 PMid:34111160 DOI: https://doi.org/10.1371/journal.pone.0252667