A comparison of the functional results and costs of functional cast and volar-flexion ulnar deviation cast at 2-year follow-up in 105 patients aged 65 and older with dorsally displaced distal radius fracture: A randomized controlled trial

Maarit Ax; Aleksi Reito; Teemu P Hevonkorpi; Vili Palola; Juha Kukkonen; Toni Luokkala; Minna K Laitinen; Antti P Launonen; Ville M Mattila

doi:10.1371/journal.pone.0283946

A comparison of the functional results and costs of functional cast and volar-flexion ulnar deviation cast at 2-year follow-up in 105 patients aged 65 and older with dorsally displaced distal radius fracture: A randomized controlled trial

PLoS One. 2023 Apr 6;18(4):e0283946. doi: 10.1371/journal.pone.0283946. eCollection 2023.

Authors

Maarit Ax¹, Aleksi Reito^{1

2}, Teemu P Hevonkorpi^{1

3}, Vili Palola¹, Juha Kukkonen⁴, Toni Luokkala³, Minna K Laitinen⁵, Antti P Launonen^{1

2}, Ville M Mattila^{1

2}

Affiliations

¹ Faculty of Medicine and Health Sciences, University of Tampere, Tampere, Finland.
² Department of Orthopedics and Traumatology, Tampere University Hospital Tampere, Tampere, Finland.
³ Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland.
⁴ Department of Orthopedics and Traumatology, Satakunta Central Hospital, Pori, Finland.
⁵ Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland.

Abstract

Background and purpose: Non-operative treatment is the most common treatment option for older patients with distal radius fracture (DRF). Traditionally, wrists have been placed in volar-flexion and ulnar deviation position (VFUDC). In recent years, there has been a trend towards using a functional position cast (FC). However, long-term results for these different casting positions are lacking.

Patients and methods: This randomized, controlled, prospective study evaluates the functional results and costs of the 2 casting positions in patients 65 and older with DRF. Primary end point in this study was Patient-Reported Wrist Evaluation (PRWE) at 24 months, and secondary end points were cost-effectiveness of treatment, health-related quality of life measurement (15D), short version of Disabilities of arm, shoulder and hand score (QuickDASH), and VAS at 24 months. The trial was registered in ClinicalTrials.gov (NCT02894983, https://clinicaltrials.gov/ct2/show/NCT02894983).

Results: We enrolled 105 patients, of which 81 (77%) continued until 24-month follow-up. 8 patients (18%) were operated in the VFUDC group and 4 (11%) in the FC group. Patients in the VFUDC group also received more frequent physical therapy. The difference in PRWE score between the VFUDC and FC groups at 24 months was -4.31. The difference in the cost of treatment per patient was €590. Both findings favored FC.

Interpretation: We found a slight, but consistent difference in the functional results between groups. These results suggest that VFUDC is not superior to FC when treating Colles' type DRF. Cost analysis revealed overall costs in the VFUDC group are nearly double those in the FC group, mostly due to more physical therapy, additional visits to hospital, and additional examinations. Therefore, we recommend FC in older patients with Colles' type DRF.

Copyright: © 2023 Ax et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Bone Plates
Casts, Surgical
Colles' Fracture* / surgery
Follow-Up Studies
Fracture Fixation, Internal / methods
Humans
Prospective Studies
Quality of Life
Radius Fractures* / surgery
Treatment Outcome
Wrist Fractures*

Associated data

ClinicalTrials.gov/NCT02894983

Grants and funding

This study has received funding from several grants from Finnish Academy and Sigrid Juselius Foundation. These grants were awarded to VM. https://www.sigridjuselius.fi/https://www.aka.fi/ None of the funders had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.