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首页> 外文期刊>Canadian Journal of Emergency Medicine >A prospective randomized controlled trial comparing circumferential casting and splinting in displaced Colles fractures
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A prospective randomized controlled trial comparing circumferential casting and splinting in displaced Colles fractures

机译：一项前瞻性随机对照试验，比较了移位的Colles骨折的环向铸造和夹板

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Objective:Our primary objective was to determine the effectiveness of 3 immobilization methods (circumferential casting [CC], volar–dorsal splinting [VDS] and modified sugar-tong [MST] splinting) in maintaining the position of displaced distal radius fractures after successful closed reduction. Our secondary objective was to assess long-term functional outcomes associated with immobilization with fibreglass splinting versus standard CC in patients maintaining initial nonoperative reductions.Methods:We conducted a prospective randomized single-blind controlled trial in patients over 18 years of age who presented to the emergency department with a displaced fracture of the distal radius requiring closed reduction. The primary outcome was loss of reduction (defined as radiologic slippage or the need for surgical fixation during the 3–4 week primary immobilization period after initial successful reduction). Secondary outcomes included DASH (disabilities of the arm, shoulder and hand) score, return to work, activities of daily living, wrist pain, range of motion and grip strength assessed at 8 weeks and 6 months.Results:Thirty participants were randomly assigned to receive MST splinting, 31 to receive VDS and 40 to receive CC. Baseline characteristics were similar among groups. Radiographic loss of reduction occurred in 16% (95% confidence interval [CI] 3.1%–28.9%) of participants in the VDS group, 20% (95% CI 7.6%–32.4%) in the CC group and 30% (95% CI 13.6°%–46.4°%) in the MST splinting group (p = 0.17). Based on multivariate analysis of variance, functional outcomes at 8 weeks were similar among groups (p = 0.89). DASH scores at 8 weeks and 6 months were similar among groups, based on 1-way analysis of variance (p > 0.25).Conclusion:Rates of loss in anatomic position were not statistically significant among the 3 types of dressings used. However, there was a clinically important trend of increased loss of reduction with the use of MST splinting. Functional outcomes at 8 weeks and 6 months were not significantly different between CC, VDS and MDS splinting. Ease of application and familiarity with use should guide clinical decisions when choosing a dressing type for displaced Colles fractures.
机译：目的：我们的主要目的是确定成功闭合后三种固定方法（周向铸造[CC]，掌侧背板[VDS]和改良的糖钳[MST]板）在维持移位的radius骨远端骨折位置中的有效性。减少。我们的次要目标是评估维持初始非手术复位的患者与玻璃纤维夹板固定与标准CC固定相关的长期功能结局。方法：我们对18岁以上的患者进行了一项前瞻性随机单盲对照试验。急诊科，远端radius骨移位骨折，需要闭合复位。主要结局为减少复位（定义为放射学滑移或初次成功复位后3-4周初次固定期间需要手术固定）。次要结果包括DASH（手臂，肩膀和手部残疾）评分，重返工作，日常生活活动，腕部疼痛，运动范围和握力强度，分别在8周和6个月进行评估。结果：将30名参与者随机分配到接收MST夹板，31接收VDS和40接收CC。各组之间的基线特征相似。 VDS组参与者的放射线减少减少率为16％（95％置信区间[CI] 3.1％–28.9％），CC组参与者为20％（95％CI 7.6％–32.4％），30％（95 MST夹板组的CI为13.6°％–46.4°％（p = 0.17）。基于方差的多变量分析，各组在8周时的功能结局相似（p = 0.89）。根据1方差分析（p> 0.25），各组在8周和6个月时的DASH评分相似。结论：所使用的三种敷料在解剖位置上的丧失率没有统计学意义。但是，使用MST夹板存在临床上重要的趋势，即减少减少的损失增加。 CC，VDS和MDS夹板在8周和6个月时的功能结局无显着差异。选择移位的Colles骨折的敷料类型时，易于应用和熟悉使用将指导临床决策。

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