Ranjit Kr Baruah1, Mohibul Islam2, Russel Haque3. 1. Professor and Head, Department of Orthopaedics, Assam Medical College, Dibrugarh 786002, Assam, India. 2. Department of Orthopaedics, Guwahati Medical College, Guwahati 32, Assam, India. 3. Department of Orthopaedics, Assam Medical College, Dibrugarh, Assam, India.
Abstract
BACKGROUND: Cast immobilisation after successful closed reduction is a standard treatment for displaced extra-articular fractures of lower end radius. The position of the wrist during immobilisation is controversial. Immobilisation in dorsiflexion prevents redisplacement after closed reduction. Our aim is to determine the effectiveness of immobilization of wrist in dorsiflexion in such cases and evaluate anatomical and functional outcome. MATERIALS AND METHODS: Study included 54 patients, above 19 years of age with closed extra-articular fractures of lower end radius treated conservatively with below elbow cast application. The wrist was maintained in 15° of dorsiflexion during plaster immobilisation. At 24 weeks, functional results were evaluated with subjective symptoms and objective signs, as per modified Demerit Point Score System. Anatomical result was evaluated based on the scheme devised by Lidstrom (1959) and modified by Sarmiento et al. (1980). RESULTS: 76% patients had Excellent to Good subjective symptoms. Out of 42 patients that had residual dorsal angulation of less than 10°, 37 had excellent to good functional outcome. 39 of the 43 patients who had loss of radial length less than 6 mm had excellent to good functional outcome. 40 out of 49 patients having loss of radial angulation less than 9° showed excellent to good functional outcome. Functional result was directly proportional to anatomical outcome. CONCLUSION: Cast immobilization of extra articular fractures of lower end radius with wrist in dorsiflexion prevents re-displacement of the fragments resulting in satisfactory anatomical & functional outcome.
BACKGROUND: Cast immobilisation after successful closed reduction is a standard treatment for displaced extra-articular fractures of lower end radius. The position of the wrist during immobilisation is controversial. Immobilisation in dorsiflexion prevents redisplacement after closed reduction. Our aim is to determine the effectiveness of immobilization of wrist in dorsiflexion in such cases and evaluate anatomical and functional outcome. MATERIALS AND METHODS: Study included 54 patients, above 19 years of age with closed extra-articular fractures of lower end radius treated conservatively with below elbow cast application. The wrist was maintained in 15° of dorsiflexion during plaster immobilisation. At 24 weeks, functional results were evaluated with subjective symptoms and objective signs, as per modified Demerit Point Score System. Anatomical result was evaluated based on the scheme devised by Lidstrom (1959) and modified by Sarmiento et al. (1980). RESULTS: 76% patients had Excellent to Good subjective symptoms. Out of 42 patients that had residual dorsal angulation of less than 10°, 37 had excellent to good functional outcome. 39 of the 43 patients who had loss of radial length less than 6 mm had excellent to good functional outcome. 40 out of 49 patients having loss of radial angulation less than 9° showed excellent to good functional outcome. Functional result was directly proportional to anatomical outcome. CONCLUSION: Cast immobilization of extra articular fractures of lower end radius with wrist in dorsiflexion prevents re-displacement of the fragments resulting in satisfactory anatomical & functional outcome.
Authors: Eva Anna Klazina van Delft; Tamara Geertruda van Gelder; Jefrey Vermeulen; Niels Willem Luitzen Schep; Frank Willen Bloemers Journal: Eur J Trauma Emerg Surg Date: 2021-08-04 Impact factor: 2.374