Conservative interventions for treating distal radial fractures in adults.

BACKGROUND

Fracture of the distal radius is a common clinical problem particularly in elderly white women with osteoporosis.

OBJECTIVES

To determine the most appropriate conservative treatment for fractures of the distal radius in adults.

SEARCH STRATEGY

We searched the Cochrane Musculoskeletal Injuries Group specialised register (January 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), MEDLINE (1966 to January 2002), EMBASE (1988 to 2002 Week 04), CINAHL (1982 to December Week 2 2001), the National Research Register (up to Issue 4, 2001) and reference lists of articles. No language restrictions were applied.

SELECTION CRITERIA

Randomised or quasi-randomised clinical trials involving skeletally mature patients with a fracture of the distal radius, which compared commonly applied conservative interventions for fracture fixation. These included the application of an external support (plaster cast or brace) and fracture manipulation.

DATA COLLECTION AND ANALYSIS

All trials, judged as fitting the selection criteria by both reviewers, were independently assessed by both reviewers for methodological quality. Data were extracted for anatomical, functional and clinical, including complications, outcomes. The trials were grouped into categories relating to cast position, extent and duration of immobilisation, use of braces, cast material and fracture manipulation. Although quantitative data from some trials are presented, the lack of good quality trials and trial heterogeneity inhibited pooling of results.

MAIN RESULTS

Two trials were newly included in this update. In all, there are 33 trials, involving a total of 3664 mainly female and older patients, meeting the inclusion criteria for this review. Comprehensive details of the individual trials are provided in tabular form, and their results, grouped as indicated above, have been presented in text and analyses tables. The poor quality and heterogeneity in terms of patient characteristics, interventions compared and outcome measurement, of the included trials meant that no meta-analyses were undertaken.

REVIEWER'S CONCLUSIONS: There remains insufficient evidence from randomised trials to determine which methods of conservative treatment are the most appropriate for the more common types of distal radial fractures in adults. Therefore, at present, practitioners applying conservative management should use an accepted technique with which they are familiar, and which is cost-effective from the perspective of their provider unit. Patient preferences and circumstances, and the risk of complications should also be considered. Further research to clarify the most appropriate conservative treatment for this common fracture is warranted but requires careful preparation with an emphasis on undertaking a systematic approach. For this, it is important to reflect on the issues raised in this review, to ascertain patient preferences, prioritise researchable questions and agree a core data set for classification of fractures and outcomes.