Does Splinting after Distal Radius Fracture Fixation Matter?: A Prospective Cohort Analysis of Post-Operative Plaster Splint versus Soft Dressing
Asif Ilyas, MD
Orthopaedics, Rothman Institute at Thomas Jefferson University, Philadelphia, PA
The effect of post-operative dressing and splinting after distal radius fracture (DRF) open reduction and internal fixation (ORIF) is not well understood. Common reasons to apply them are for pain control, edema control, and to protect the fracture repair. However, splinting and casting takes time and has a cost. A prospective cohort analysis was performed to assess differences in functional and radiographic outcomes with use of plaster splinting or soft dressing following DRF ORIF. The hypothesis was that there would be no difference in outcome with type of splinting after DRF ORIF.
All patients undergoing DRF ORIF with locking volar plates were consecutively enrolled. Pre-operative demographic, and post-operative radiographic and functional outcomes were collected 2 weeks and 3 months post-operatively. Functional data included range of motion (ROM), pain on visual analog pain scale (VAS), Patient Rated Wrist Evaluation (PRWE), and Quick-DASH scores. Radiographic data included loss of fracture reduction.
There were 139 patients enrolled (79 plaster splinting, 60 soft dressing). By the first post-operative visit (POV) there were 2 cases of loss of reduction with plaster splinting and 1 with soft dressing, but otherwise no difference in DASH, PRWE, or VAS pain scores. By the final POV, there were 2 cases of loss of reduction with plaster splinting and 3 with soft dressing. The soft dressing group showed an overall greater ROM in extension by 9.7, flexion by 10.9, and supination by 4.8 degrees over the plaster splint group. There were no statistically significant differences in PRWE or DASH scores at either POV's, and only a minor improvement in VAS of 0.5 for the soft dressing group by the final POV.
The hypothesis was "essentially" upheld, there was no clinically significant difference between the two groups. Applying only a soft dressing following DRF ORIF demonstrated slight improvements in ROM and VAS by final follow-up, with no significant differences in functional outcomes or radiographic outcomes. No additional benefit for applying a plaster splint was identified. The use of a plaster splint should be re-considered due to its lack of clinical advantage and potentially increased time and cost of application.
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