Management of undisplaced or minimally displaced distal radius fractures in adults: immobilization with circumferential casting versus plaster splinting.

BACKGROUND

Distal radius fractures (DRFs) are among the most common fractures in adults, with a significant proportion being stable, non-displaced, or minimally displaced. These fractures generally have a low risk of secondary displacement. This study aimed to compare the clinical and radiological outcomes of short-arm circular casting and volar splint application in the conservative treatment of stable distal radius fractures. Additionally, the study evaluated complication rates, patient comfort, and the feasibility of these two immobilization techniques in emergency department settings.

METHODS

This retrospective study reviewed the medical records of 170 patients diagnosed with stable, non-displaced, or minimally displaced distal radius fractures at two emergency departments between January 2020 and January 2023. Fracture stability was assessed using Lindstrom's criteria. Among the participants, 88 patients were treated with short-arm circular casting, while 82 received volar splint application. Immobilization was maintained for four weeks, followed by a six-month follow-up period. Radiographic parameters (radial height, radial inclination, palmar tilt, and articular surface step-off) were measured at baseline and during follow-up visits. Clinical and functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) and Patient-Rated Wrist Evaluation (PRWE) scales. Complication rates and patient satisfaction were also analyzed.

RESULTS

The study included 170 patients (mean age: 46.9±11.4 years). No statistically significant differences were observed between the casting and splint groups in terms of radiological parameters at baseline or six months post-treatment (p>0.05). Similarly, clinical and functional outcomes, including qDASH and PRWE scores, were comparable between the two groups (p>0.05). Complication rates were 5.7% in the cast group and 4.8% in the splint group, with no significant difference (p>0.05). The volar splint technique demonstrated advantages in terms of ease of application and patient comfort.

CONCLUSION

Short-arm circular casting and volar splinting provide equivalent clinical and functional outcomes in the management of stable distal radius fractures. Given its ease of application and greater patient comfort, volar splinting can be considered a practical alternative in emergency department settings, particularly for selected patient populations.