Circumferential Casting of Distal Radius Fractures

To determine the prevalence and predictive factors for early cast alteration (splitting, trimming, complete replacement) in patients with distal radius fractures (DRFs) treated in circumferential cast. To determine if performing early cast alterations affects fracture alignment. Retrospective Cohort Study SETTING:: Level 1 Trauma Center PATIENTS:: All adult patients who presented with a DRF to a tertiary care hospital over a three-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 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 early cast alteration, and secondarily to determine the effect of these alterations on fracture alignment. 296 patients were included in the study. One out of every 4-5 patients had their cast altered within the first 10 days of treatment. One out 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 at 6 weeks. Cast alteration is commonplace after casting of distal radius fractures, but is not associated with loss of alignment. Polytrauma patients may benefit from immediate cast splitting. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.