Circumferential Casting of Distal Radius Fractures

Objectives: 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. Design: Retrospective Cohort Study. Setting: Level 1 Trauma Center. Patients: All adult patients who presented with a DRF to a tertiary care hospital over a 3-year period. Intervention: All DRFs without immediate surgical indications are initially treated with circumferential casts at this center. Outcome Measurements: 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. Results: 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. Conclusions: 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.