Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-80448

Dorsoradial vs Circular Cast for Distal Radius Fractures: A Retrospective Comparative Cohort Study

Oðuzhan Gökalp, Gökhan Ilyas
Uþak University, Medical Faculty

Background
Non-articular dorsally angulated distal-radius fractures (DRFs) are often treated conservatively, yet the optimal cast design remains debated. Dorsoradial (DR) casting leaves the ulnar border open and may better accommodate swelling, potentially lowering early cast-related interventions.

Methods
A single-center retrospective cohort of adults with AO-23-A2/A3 DRFs (May 2019 – May 2023) was analysed. Patients received either a DR cast (n = 88) or a conventional circular cast (CC; n = 122) for a standard 5-week immobilisation. Primary outcomes were functional (Patient-Rated Wrist Evaluation, PRWE) and clinical (Gartland-Werley, GW) scores plus radiographic alignment (volar tilt, radial inclination, radial height) at a median 118.5-week follow-up. Secondary outcomes included early cast revision (release / reinforcement) and complications. Statistical tests: Mann-Whitney U, χ²/Fisher, Bonferroni-adjusted α = 0.017.

Results
Baseline age (mean 60 ± 11 yr), sex (87 % female), AO subtype and osteoporosis status were comparable.
Early revision: DR 22.7 % vs CC 36.1 % (absolute risk reduction 13 %-points; OR 0.51, p = 0.038), driven by cast release for swelling/pain (12.5 % vs 32.8 %, p = 0.001).
Function: PRWE 34 ± 18 (DR) vs 36 ± 18 (CC), p = 0.435; GW good–excellent in 79.5 % vs 77.8 %, p = 0.508.
Radiology: Final volar tilt and radial height did not differ (both p > 0.08). DR casts preserved radial inclination (median change 0°, p = 0.057) whereas CC casts lost 1.3° (-6 %, p < 0.001); the net 1.2° inter-group gap is below the 5° MCID and clinically negligible. No compartment syndrome or acute carpal tunnel occurred.

Conclusions
Dorsoradial casting delivers functional and radiographic outcomes equivalent to circular casting while cutting early revision rates by one-fifth. By reducing unplanned cast adjustments and follow-up visits, the DR technique represents a pragmatic alternative for centers with limited monitoring capacity treating dorsally angulated extra-articular DRFs.

Keywords: distal-radius fracture, dorsoradial cast, circular cast, PRWE, conservative treatment

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Distal Radius Kýrýklarýnda Dorsoradial ve Sirküler Alçýnýn Karþýlaþtýrýlmasý: Retrospektif Karþýlaþtýrmalý Kohort Çalýþmasý

Oðuzhan Gökalp, Gökhan Ilyas
Uþak Üniversitesi, Týp Fakültesi

Amaç
Eklem dýþý, dorsal açýlý distal radius kýrýklarýnýn (DRK) konservatif tedavisinde en uygun alçý tasarýmý tartýþmalýdýr. Ulnar kenarý açýk býrakan dorsoradial (DR) alçýnýn þiþmeye uyum saðlayarak erken alçý müdahalesi gereksinimini azaltabileceði öne sürülmektedir.

Gereç-Yöntem
Mayýs 2019-Mayýs 2023 arasýnda AO-23-A2/A3 DRK tanýsý alýp beþ hafta immobilize edilen yetiþkinler tek merkezli geriye dönük kohorta dâhil edildi. Hastalar DR alçý (n = 88) veya dairesel alçý (DA; n = 122) aldý. Birincil sonlanýmlar: Hasta Deðerlendirmeli El Bileði Skoru (PRWE), Gartland-Werley (GW) kliniði ve radyolojik açý-ölçüleri (volar tilt, radial inklinasyon, radial yükseklik) – medyan 118,5 haftada. Ýkincil sonlanýmlar: erken alçý revizyonu (gevþetme/takviye) ve komplikasyonlar. Ýstatistik: Mann-Whitney U, χ²/Fisher; çoklu karþýlaþtýrmada Bonferroni düzeltmesi (α_adj = 0,017).

Bulgular
Gruplar yaþ (ortalama 60 ± 11 yýl), cinsiyet (% 87 kadýn), AO alt tipi ve osteoporoz açýsýndan benzerdi.
Erken revizyon: DR % 22,7 vs DA % 36,1 (mutlak risk azalmasý 13 puan; OR 0,51; p = 0,038); fark en çok þiþme/aðrý için alçý gevþetmede görüldü (% 12,5 vs % 32,8; p = 0,001).
Fonksiyon: PRWE 34 ± 18 (DR) vs 36 ± 18 (DA); p = 0,435. GW’de iyi-mükemmel oraný % 79,5 vs % 77,8; p = 0,508.
Radyoloji: Son volar tilt ve radial yükseklik farký yok (p > 0,08). DR alçý radial inklinasyonu korudu (medyan deðiþim 0°, p = 0,057); DA alçýda 1,3° kayýp vardý (p < 0,001). Gruplar arasý net 1,2° fark, 5°’lik MCID eþiðinin altýndadýr ve klinik açýdan önemsizdir. Hiçbir hastada kompartman sendromu veya akut karpal tünel sendromu görülmedi.

Sonuç
Dorsoradial alçý, fonksiyonel ve radyolojik açýdan dairesel alçýya eþdeðer sonuç verirken erken alçý revizyonu gereksinimini beþte bir oranýnda azaltýr. Bu sayede plan dýþý poliklinik ziyareti ve operasyon ihtiyacýný düþürerek, takip kapasitesi kýsýtlý kliniklerde dorsal açýlý, eklem dýþý DRK’nýn konservatif tedavisinde pratik bir alternatif sunar.

Anahtar Kelimeler: distal radius kýrýðý, dorsoradial alçý, dairesel alçý, PRWE, konservatif tedavi

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