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Reverse Sugar Tong Splints for Distal Radius Fractures: Preserving Elbow Motion Without Compromising Outcomes
Richard Lander, MD
1, Derek T. Schloemann, MD, MPHS
1, Brittany Haws, MD
2, Joanna Whitbeck, PAC
2; Bilal Mahmood, MD
2(1)University of Rochester Medical Center, Rochester, NY, (2)University of Rochester, Rochester, NY
Background
Distal radius fractures (DRFs) are often immobilized in sugar tong splints (STS) which extend proximal to the elbow and immobilize the forearm in fixed rotation. The reverse sugar tong splint (rSTS) (Figure 1) extends to the proximal forearm and has the benefit of maintaining elbow range of motion and exposure of the antecubital fossa. Our objective was to compare radiographic alignment and post-reduction complications of patients undergoing nonoperative treatment of distal radius fractures immobilized in STS and rSTS.
Methods & Materials:
Adult patients presenting to a level one trauma center between June 26, 2019 and June 23, 2020 with an isolated DRF who underwent closed reduction were included in the study. Patients were excluded if they had an open fracture, were not immobilized in a STS or rSTS, or if they were initially indicated for operative treatment. Splint choice was based on the surgeon on-call regardless of fracture morphology. Radiographic parameters were measured at pre-reduction, post-reduction and first follow-up visit time points. Statistical comparisons were performed using Mann Whitney U test and chi square test with a statistical significance set at p<0.05.
Results:
63 patients were included in the final analysis. The average age was 58, and 48 were female (Table 1). The STS cohort had significantly more patients with BMI>30. 49% of the injuries occurred in the dominant upper extremity. There was no difference in radiographic alignment between splint types at any time point (Table 2). The mean time for first follow up visit was 10 days (SD:5). Six patients in each cohort had loss of reduction by radiographic parameters. Two patients immobilized with rSTS and one patient immobilized with STS failed nonoperative treatment leading to operative intervention.
Conclusion:
We found no significant difference in outcomes for DRFs undergoing nonoperative treatment following closed reduction with immobilization in STS compared to rSTS. Surgeons may consider immobilizing DRFs with a rSTS due to maintained elbow range of motion and exposure without concern for worse outcomes.
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