Distal Radius Plaster Immobilization Period I; A randomized trial comparing three weeks of plaster cast immobilization versus five weeks of plaster cast immobilization in adult patients with distal radius fractures.

The incidence of distal radial fractures is 400/100.000 in the Netherlands.
Therefore, these fractures represent a large amount of the daily workload for
practicing orthopedic and trauma surgeons. Most patients with distal radius
fractures can be treated non-operatively in a plaster of Paris, with excellent
functional results.

Distal radial fractures are usually treated on an outpatient basis . In the
last 100 years, most distal radial fractures in adults have been treated
conservatively. Over the last decade, concurrent with the introduction of
locking plates, open reduction and internal fixation of distal radial fractures
has become more popular. The choice of treatment methods is also influenced by
the patient's general medical condition, the expected functional loading
(activity demands), and patient motivation.

In case of conservative treatment of distal radius fractures a little is known
about the duration of plaster cast immobilization. Usually a period of 4 till
five weeks is chosen. Christensen showed in a clinical controlled trial with 33
patient that immobilization of nearly of non-dislocated distal radius fractures
could be reduced from 5 till 3 weeks. Vang Hansen confirmed these findings
later with a prospective comparative with 100 patients. Jensen showed in a
randomized trial with 62 patients that even one week of immobilization was
sufficient.
In the above mentioned studies it has already been shown that a reduction in
period of immobilization could be possible. However the above mentioned studies
have their limitations in follow up and their modest group of patients.

The aim of the study is to compare the functional outcome of distal radial
fractures after three weeks of plaster cast immobilization with five weeks of
plaster cast immobilization. We think that a shorter immobilization period of
distal radial fractures lead to a better finctional outcome.

This study will be conducted as a prospective randomized controlled clinical
trial in which three weeks of plaster cast immobilization is compared to five
weeks of plaster cast immobilization. Patients with distal radius fractures
will be initially managed on the emergency department. Using the criteria for
misalignment (dorsal angulation >15°, volar tilt >20°, radial inclination >15°
and, ulnar variance >5mm) the patients will be included if closed reduction is
not necessary.
Patients will be asked informed consent after fulfilling the above-mentioned
inclusion and exclusion criteria. Two (non-treating) trauma surgeons as
external referees will also determine the degree of misalignment and the AO
classification blinded from the scoring by the treating physician. Thereafter
patients will be randomized into a group in which the plaster cast
immobilization is continued for three weeks or five weeks.

One group will have three weeks of plaster immbilization and the other group
will have five weeks of plaster immobilization

Literature indicates that both treatment options from the study are accepted
for distal radius fractures. No clear advantage for one treatment options is
found at present in the literature, although there is no level I evidence
present. Both treatment options have their known complications: stiffness of
the joint and pain due to malunion.
The expectation of this study is that three weeks of plaster immobilization is
beneficial for the patient with a distal radius fracture. This risk of specific
complications is low and generally similar in both treatment options.
Moreover, the burden of the study is not much higher compared to standard
treatment.