Not enough evidence to tell what type of non-surgical treatment is best for treating a broken wrist

In older women, a broken wrist (from a fracture at the lower end of one of the two forearm bones) can result from a fall onto an outstretched hand. Treatment is usually non-surgical and may include putting the broken bone back into position and immobilising the wrist in a plaster or brace. There was not enough evidence from trials to determine whether, and if so when, moderately displaced fractures should be manipulated back into position. Nor was there enough evidence to determine the best method and duration of immobilisation.

Authors' conclusions: 

There remains insufficient evidence from randomised controlled trials to determine which methods of conservative treatment are the most appropriate for the more common types of distal radial fractures in adults. Therefore, at present, practitioners applying conservative management should use an accepted technique with which they are familiar, and which is cost-effective from the perspective of their provider unit. Patient preferences and circumstances, and the risk of complications should also be considered.

Prioritising research questions to clarify the most appropriate conservative treatment for this common fracture is warranted. Researchers should differentiate between extra-articular and intra-articular, and non-displaced and displaced fractures, ascertain patient preferences, and agree a core outcome data set.

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Background: 

Fracture of the distal radius is a common clinical problem particularly in elderly white women with osteoporosis.

Objectives: 

To determine the most appropriate conservative treatment for fractures of the distal radius in adults.

Search strategy: 

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (June 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2005), MEDLINE, EMBASE, CINAHL, PEDro, the National Research Register (UK), conference proceedings and reference lists of articles.

Selection criteria: 

Randomised or quasi-randomised controlled clinical trials involving skeletally mature people with a fracture of the distal radius, which compared commonly applied conservative interventions for fracture fixation. These included the application of an external support (plaster cast or brace) and fracture manipulation.

Data collection and analysis: 

Both review authors performed independent trial selection and quality assessment. Data were extracted for anatomical, functional and clinical, including complications, outcomes. The trials were grouped into categories relating to manipulation of displaced fractures; use and extent, including forearm position, of immobilisation; use of braces; different casting materials and techniques; and duration of immobilisation. Although quantitative data from some trials are presented, the lack of good quality trials and trial heterogeneity inhibited pooling of results.

Main results: 

One trial was newly included in this update. In all, there are 37 trials, involving a total of 4215 mainly female and older patients, meeting the inclusion criteria for this review. Comprehensive details of the individual trials are provided in tabular form, and their results, grouped as indicated above, have been presented in text and graphs. The poor quality and heterogeneity in terms of patient characteristics, interventions compared and outcome measurement, of the included trials meant that no meta-analyses were undertaken.

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