Drager Justin, Carli Alberto, Matache Bogdan A, Berry Gregory K, Reindl Rudy, Harvey Edward J
*Division of Orthopedic Surgery, McGill University Health Center, Montreal General Hospital, Montreal, Canada; and †Faculty of Medicine, McGill University, Montreal, Canada.
J Orthop Trauma. 2014 Aug;28(8):e186-90. doi: 10.1097/BOT.0000000000000045.
To determine the prevalence and predictive factors for the early cast alteration (splitting, trimming, and complete replacement) in patients with distal radius fractures (DRFs) treated in circumferential cast. To determine whether performing early cast alterations affects the fracture alignment.
Retrospective Cohort Study.
Level 1 Trauma Center.
All adult patients who presented with a DRF to a tertiary care hospital over a 3-year period.
All DRFs without immediate surgical indications are initially treated with circumferential casts at this center.
The following variables were analyzed: patient demographics, polytrauma at the time of injury, physician subspecialty performing reduction, and type of cast alteration. Radiographs were used to assess initial fracture characteristics and secondary displacement of reduction over time. Analysis was performed primarily to identify predictive variables for the early cast alteration and secondarily to determine the effect of these alterations on fracture alignment.
296 patients were included in the study. One of every 4-5 patients had their cast altered within the first 10 days of treatment. One of 3 polytrauma patients had their cast altered. No type of cast alteration was found to be significantly predictive of loss of fracture alignment at 2 or 6 weeks.
Cast alteration is commonplace after casting of DRFs but is not associated with the loss of alignment. Patients with polytrauma may benefit from immediate cast splitting.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
确定采用环形石膏治疗的桡骨远端骨折（DRF）患者早期石膏改变（裂开、修剪和完全更换）的发生率及预测因素。确定早期进行石膏改变是否会影响骨折对线。
回顾性队列研究。
一级创伤中心。
在3年期间因DRF就诊于三级护理医院的所有成年患者。
该中心所有无立即手术指征的DRF患者最初均采用环形石膏治疗。
分析以下变量：患者人口统计学资料、受伤时的多发伤情况、进行复位的医生亚专业以及石膏改变类型。使用X线片评估初始骨折特征及复位后随时间的二次移位情况。主要进行分析以确定早期石膏改变的预测变量，其次确定这些改变对骨折对线的影响。
296例患者纳入研究。每4 - 5例患者中有1例在治疗的前10天内石膏被改变。每3例多发伤患者中有1例石膏被改变。未发现任何类型的石膏改变能显著预测2周或6周时骨折对线的丢失。
DRF患者石膏固定后石膏改变很常见，但与对线丢失无关。多发伤患者可能从立即石膏裂开中获益。
预后II级。有关证据水平的完整描述，请参阅《作者须知》。
