Immobilization Time for Conservative Treatment of Distal Radial Fractures in Elderly Patients: A Randomized Controlled Trial.

IF 4.3 1区医学 Q1 ORTHOPEDICS

Journal of Bone and Joint Surgery, American Volume Pub Date : 2025-06-05 DOI:10.2106/JBJS.24.01480

A Sala-Pujals, A Portes Chiva, J Chillon Soria, D Valverde Vilamala, E Dominguez Font, A Pardo Pol

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引用次数: 0

Abstract

Background: The management of distal radial fractures (DRFs) in elderly patients remains controversial. Although conservative treatment with cast immobilization is widely accepted, the optimal duration for immobilization is unclear. This study aimed to compare pain control, functional outcomes, and complication rates between 4-week and 6-week immobilization periods in elderly patients treated nonoperatively for displaced DRFs.

Methods: A single-center randomized controlled trial was conducted, including 150 patients who were ≥65 years of age and had displaced DRFs. Patients were randomized into 2 groups: 4-week immobilization and 6-week immobilization. Pain was assessed using a visual analog scale (VAS) at 10 days after removing the cast and then at 3, 6, and 12 months after injury. Functional outcomes were measured using the Patient-Rated Wrist Evaluation (PRWE) and QuickDASH (the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire) at 3, 6, and 12 months. Radiographs were reviewed for malunion, and complications and range of motion were also evaluated.

Results: In the 135 patients analyzed, no differences were observed in pain or functional outcomes between the 2 groups at any time point. VAS scores 10 days after the cast removal were similar (3.87 for the 4-week immobilization group and 4.00 for the 6-week group; p = 0.67), as were PRWE scores (14.18 for the 4-week group and 15.51 for the 6-week group; p = 0.686) and QuickDASH scores (15.46 for the 4-week group and 17.86 for the 6-week group; p = 0.449) after 1 year. The malunion rates were 29.9% in the 4-week group and 32.8% in the 6-week group (p = 0.85), and there were no significant differences in complications or range of motion between groups.

Conclusions: A 4-week immobilization period provided equivalent pain control, functional outcomes, and complication rates as a 6-week immobilization period in elderly patients with displaced DRFs treated nonoperatively. Therefore, a shorter immobilization period may be safely recommended for treating these fractures.

Level of evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

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老年患者桡骨远端骨折保守治疗的固定时间：一项随机对照试验。

背景：老年患者桡骨远端骨折（DRFs）的治疗仍然存在争议。尽管保守治疗用石膏固定被广泛接受，但最佳固定时间尚不清楚。本研究旨在比较非手术治疗移位性DRFs的老年患者4周和6周固定期间的疼痛控制、功能结局和并发症发生率。方法：采用单中心随机对照试验，纳入150例年龄≥65岁、有移位性DRFs的患者。患者随机分为2组：固定4周和固定6周。在拆除石膏后10天，然后在受伤后3、6和12个月，使用视觉模拟评分（VAS）评估疼痛。在3个月、6个月和12个月时，使用患者评定腕部评估（PRWE）和QuickDASH（手臂、肩膀和手的残疾问卷的缩写版本）来测量功能结果。我们回顾了骨折愈合的x线片，并对并发症和活动范围进行了评估。结果：在分析的135例患者中，两组在任何时间点的疼痛或功能结局均无差异。拆除石膏后10天的VAS评分相似(固定4周组为3.87，固定6周组为4.00；p = 0.67)， PRWE评分也是如此(4周组为14.18,6周组为15.51；p = 0.686)和QuickDASH评分(4周组15.46,6周组17.86；P = 0.449)。术后4周组畸形愈合率为29.9%，术后6周组畸形愈合率为32.8% (p = 0.85)，两组术后并发症及关节活动度差异无统计学意义。结论：在非手术治疗的老年移位性DRFs患者中，4周的固定期提供了与6周固定期相同的疼痛控制、功能结果和并发症发生率。因此，较短的固定时间可以安全地被推荐用于治疗这些骨折。证据水平：治疗性i级。参见《作者说明》获得证据水平的完整描述。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.