Advertisement

Radiographic evaluation of acute distal radius fracture stability: A comparative cadaveric study between a thermo-formable bracing system and traditional fiberglass casting

  • Brandon G. Santoni
    Correspondence
    Corresponding author at: Foundation for Orthopaedic Research and Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA.
    Affiliations
    Foundation for Orthopaedic Research and Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA

    Department of Orthopaedics and Sports Medicine, University of South Florida, 13330 USF Laurel Drive, Tampa, FL 33612, USA
    Search for articles by this author
  • Jazmine R. Aira
    Affiliations
    Foundation for Orthopaedic Research and Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA

    Department of Chemical and Biomedical Engineering, University of South Florida, 4202 E. Fowler Avenue, ENB 118, Tampa, FL 33612, USA
    Search for articles by this author
  • Miguel A. Diaz
    Affiliations
    Foundation for Orthopaedic Research and Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA
    Search for articles by this author
  • T. Kyle Stoops
    Affiliations
    Foundation for Orthopaedic Research and Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA
    Search for articles by this author
  • Peter Simon
    Affiliations
    Foundation for Orthopaedic Research and Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA

    Department of Chemical and Biomedical Engineering, University of South Florida, 4202 E. Fowler Avenue, ENB 118, Tampa, FL 33612, USA

    Department of Orthopaedics and Sports Medicine, University of South Florida, 13330 USF Laurel Drive, Tampa, FL 33612, USA
    Search for articles by this author

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bonafede M.
        • Espindle D.
        • Bower A.G.
        The direct and indirect costs of long bone fractures in a working age US population.
        J. Med. Econ. 2013; 16: 169-178
        • Boyd A.S.
        • Benjamin H.J.
        • Asplund C.
        Principles of casting and splinting.
        Am. Fam. Physician. 2009; 79: 16-22
        • Fernandez D.L.
        Closed manipulation and casting of distal radius fractures.
        Hand Clin. 2005; 21: 307-316
        • Field J.
        • Protheroe D.L.
        • Atkins R.M.
        Algodystrophy after Colles fractures is associated with secondary tightness of casts.
        J. Bone Joint Surg. (Br.). 1994; 76: 901-905
        • Gutow A.P.
        Avoidance and treatment of complications of distal radius fractures.
        Hand Clin. 2005; 21: 295-305
        • Halanski M.
        • Noonan K.J.
        Cast and splint immobilization: complications.
        J. Am. Acad. Orthop. Surg. 2008; 16: 30-40
        • Kilgore M.L.
        • Morrisey M.A.
        • Becker D.J.
        • Gary L.C.
        • Curtis J.R.
        • Saag K.G.
        • Yun H.
        • Matthews R.
        • Smith W.
        • Taylor A.
        • Arora T.
        • Delzell E.
        Health care expenditures associated with skeletal fractures among medicare beneficiaries, 1999–2005.
        J. Bone Miner. Res. 2009; 24: 2050-2055
        • MacIntyre N.J.
        • Dewan N.
        Epidemiology of distal radius fractures and factors predicting risk and prognosis.
        J. Hand Ther. 2016; 29: 136-145
        • Mehling I.
        • Muller L.P.
        • Delinsky K.
        • Mehler D.
        • Burkhart K.J.
        • Rommens P.M.
        Number and locations of screw fixation for volar fixed-angle plating of distal radius fractures: biomechanical study.
        J. Hand. Surg. [Am.]. 2010; 35: 885-891
        • Moss D.P.
        • Means Jr., K.R.
        • Parks B.G.
        • Forthman C.L.
        A biomechanical comparison of volar locked plating of intra-articular distal radius fractures: use of 4 versus 7 screws for distal fixation.
        J. Hand. Surg. [Am.]. 2011; 36: 1907-1911
        • Wall L.B.
        • Brodt M.D.
        • Silva M.J.
        • Boyer M.I.
        • Calfee R.P.
        The effects of screw length on stability of simulated osteoporotic distal radius fractures fixed with volar locking plates.
        J. Hand. Surg. [Am.]. 2012; 37: 446-453
        • Zaino C.J.
        • Patel M.R.
        • Arief M.S.
        • Pivec R.
        The effectiveness of bivalving, cast spreading, and webril cutting to reduce cast pressure in a fiberglass short arm cast.
        J. Bone Joint Surg. Am. 2015; 97: 374-380