Highlights
- •Stability with a thermo-formable brace and fiberglass cast was evaluated in fractured arms.
- •Fracture fragment movement under increasing load was measured radiographically.
- •Gross fragment movement was measured under 4.5N of load in the non-stabilized forearm.
- •Stabilization with the brace and cast eliminated fracture fragment motion under the 4.5N load.
- •There was no difference in fragment movement between braced and casted forearms under 67N.
Abstract
Background
Distal radius fractures are common musculoskeletal injuries and many can be treated
non-operatively with cast immobilization. A thermo-formable brace has been developed
for management of such fractures, but no data exist regarding its comparative stabilizing
efficacy to fiberglass casting.
Methods
A worst-case distal radius fracture was created in 6 cadaveric forearms. A radiolucent
loading fixture was created to apply cantilever bending/compression loads ranging
from 4.5N to 66.7N across the simulated fracture in the: (1) non-stabilized, (2) braced;
and (3) casted forearms, each forearm serving as its own control. Fracture fragment
translations and rotations were measured radiographically using orthogonal radiographs
and a 2D-3D, CT-based transformation methodology.
Findings
Under 4.5N of load in the non-stabilized condition, average sagittal plane rotation
and 3D center of mass translation of the fracture fragment were 12.3° and 5.3 mm, respectively. At the 4.5N load step, fragment rotation with the brace (avg. 0.0°)
and cast (0.1°) reduced sagittal plane rotation compared to the non-stabilized forearm
(P < 0.001). There were no significant differences in measured sagittal plane fracture
fragment rotations or 3D fragment translations between the brace or cast at any of
the four load steps (4.5N, 22.2N, 44.5N, and 66.7N, P ≥ 0.138).
Interpretation
In this in vitro radiographic study utilizing 6 cadaveric forearms with simulated
severe-case, unstable and comminuted distal radius fractures, the thermo-formable
brace stabilized the fracture in a manner that was not radiographically or biomechanically
different from traditional fiberglass casting. Study results support the use of the
thermo-formable brace clinically.
Keywords
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Article info
Publication history
Published online: May 18, 2017
Accepted:
May 18,
2017
Received:
December 13,
2016
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.