Publication: Effectiveness of below elbow cast as the primary modality in immobilisation of distal end radius fractures: A systematic review and meta-analysis
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Date
2022
Authors
Mardi, Maria
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Abstract
Introduction Distal end radius fracture can be treated conservatively when acceptable alignment is obtained by closed manipulation. Different types of immobilisers have been used to maintain fracture reduction. Objective Our study objective was to investigate the effectiveness of below elbow cast in giving good radiological and functional outcomes in this fracture management, and to observe the prevalence of its adverse effects, compared to other type of immobilisers. Methodology We searched through electronic online databases namely Google Scholar, Web of Science, Scopus, PubMed and Cochrane, and included 15 studies with a total of 1373 patients for systematic review and meta-analysis. Random-effects model with 95% confidence interval (CI) was used in calculating the mean differences (MDs) and odds ratios (ORs). A predefined protocol was registered with PROSPERO, an international prospective registry for systematic reviews, based in University of York, United Kingdom (Registration No CRD42021231480). Results There was a significant difference in the percentage of loss of fracture reduction, favouring the below elbow cast group compared to other immobilisers (OR: 0.61; 95% CI: 0.38-0.98; p=0.04; I2=0%), also specifically when compared to above elbow cast (OR: 0.50; 95% CI: 0.29-0.86; p=0.01; I2=0%). Functional outcomes, namely the Disabilities of the Arm, Shoulder and Hand (DASH) and visual analogue scale (VAS) scores, showed no significant difference between below elbow cast and other immobilisers (DASH: MD: -0.11; 95% CI: -1.50-1.28; p=0.88; I2=0%), (VAS: MD: 0.51; 95% CI: -0.19-1.20; p=0.15; I2=87%). The prevalence of adverse effects is generally low in all immobilisers, even more with below elbow cast. Conclusion Our results suggest that below elbow cast serves its purpose as the best option for immobilisation in adult distal end radius fractures without jeopardising radiological outcome, while having low complication rate
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Keywords
below elbow cast , distal end radius fracture