Department of Orthopedic Surgery, University of Connecticut Health Center, United States of America.
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, United States of America.
Am J Emerg Med. 2022 Jun;56:124-126. doi: 10.1016/j.ajem.2022.03.017. Epub 2022 Mar 15.
Controversy exists regarding the closed treatment of distal radius fractures. Circumferential casting of acute distal radius fractures has been shown to be safe in children, however, little research has demonstrated its safety in adults. The purpose of this study was to assess the risk of complications associated with casting acute distal radius fractures in adult patients.
Patients with a distal radius fracture treated by a single hand surgeon at a level 1 trauma center were retrospectively reviewed over a 3-year period. Patients were evaluated in the emergency room and were provisionally immobilized either with short-arm fiberglass casts or with splints. Patients were followed for a minimum of 4 weeks. Complication rates associated with casting were recorded, including rates of compartment syndrome and acute carpal tunnel syndrome.
Eighty-one patients were included in this study. A total of 30 patients met inclusion criteria for placement of a short arm cast in the Emergency Department. Mean patient age was 63.2 years. The majority of patients sustained their injuries from a ground level fall. A minority of patients had radiographic evidence of intra-articular extension or underwent a reduction prior to casting. There were no patients who developed compartment syndrome or acute carpal tunnel syndrome as a result from the casting. The majority of patients did not require a cast change for at least 4 weeks. None of our patients went on to surgery.
There were no major complications associated with casting of acute, low energy distal radius fractures in this series of 30 adult patients. While further studies with larger numbers of patients are necessary to establish safety of casting, this study suggests that casting may be a safe and effective treatment for low-energy distal radius fractures in adult patients presenting with a normal neurovascular exam.
TYPE OF STUDY/LEVEL OF EVIDENCE: Retrospective comparative study, Level III.
对于桡骨远端骨折的闭合治疗存在争议。已证明环状固定急性桡骨远端骨折在儿童中是安全的，但很少有研究证明其在成人中的安全性。本研究旨在评估在成年患者中对急性桡骨远端骨折进行石膏固定相关并发症的风险。
对 3 年内由一名手部外科医生在 1 级创伤中心治疗的桡骨远端骨折患者进行回顾性研究。患者在急诊室进行评估，并临时用短臂玻璃纤维石膏或夹板进行固定。患者至少随访 4 周。记录与石膏固定相关的并发症发生率，包括筋膜间室综合征和急性腕管综合征的发生率。
本研究共纳入 81 例患者。共有 30 例患者符合在急诊科放置短臂石膏的纳入标准。患者的平均年龄为 63.2 岁。大多数患者因平地跌倒受伤。少数患者有影像学证据表明关节内延伸或在石膏固定前进行了复位。没有患者因石膏固定而发生筋膜间室综合征或急性腕管综合征。大多数患者至少 4 周内不需要更换石膏。我们没有患者需要手术。
在这 30 例成年患者的急性低能量桡骨远端骨折系列中，石膏固定没有出现重大并发症。虽然需要进一步进行更大样本量的研究以确定石膏固定的安全性，但本研究表明，对于表现为正常神经血管检查的成年患者，石膏固定可能是一种安全有效的低能量桡骨远端骨折治疗方法。
研究类型/证据水平：回顾性比较研究，III 级。
