Session X - Upper Extremity
The Aberdeen Colles-Fracture Brace: An Alternative Treatment for Colles Fracture: A Prospective Randomized Multicenter Study
Nezar S. Tumia, FRCS1; Douglas Wardlaw, FRCS1; Jeffrey P. Hallett, FRCS2; Robert Deutman, MD3; Sten A. Mattsson, MD4; Bengt Sandén, MD4; 1Department of Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, United Kingdom; 2Department of Orthopaedics, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, England; 3Department of Orthopaedics, Martini Hospital, Groningen, The Netherlands; 4Department of Orthopaedics, University Hospital, Uppsala, Sweden
Purpose: The morbidity associated with the Colles cast immobilization in treating Colles fracture includes stiffness and reduced strength and function of the hand and fingers, which has led to an increased interest in an alternative treatment using a functional brace. The Aberdeen Colles fracture brace (AFB) is a prefabricated brace that maintains fracture reduction by applying three-point loading and at the same time allowing movement at the wrist joint. We compared the outcome of the management of Colles fractures with use of the AFB and with use of a conventional plaster of Paris (POP) cast.
Methods: A randomized prospective multicenter clinical trial was carried out; 339 patients with Colles fractures were treated at five different trauma centers. Patients were stratified into two groups: group 1, 151 patients who had minimally displaced fractures not requiring manipulation, and group 2, 188 patients who had displaced fractures requiring manipulation. Both groups were treated with either a conventional POP cast or the AFB.
The functional and anatomical assessments were made using the modified Gartland and Werley scoring system and the radiological displacement method (Bunger et al., 1984), respectively. The relative grip strength of the injured hand was calculated for each patient. Pain and discomfort assessment was made according to pain scores: 0, no pain; 1, occasional pain on heavy activity; 2, often pain on heavy activity; 3, often pain on normal activity; and 4, often pain at rest.
Results: Both the AFB and POP treatment groups gave similar anatomical scores and pain scores. Hand grip strength was better among patients in the AFB group than in the POP cast group. However, there was no statistically significant difference in the functional scores.
Discussion: There was no significant difference in the anatomical scores between either treatment. The AFB was as effective as the POP cast in maintaining fracture reduction in treating both manipulated and non-manipulated fractures. In addition, there was no significant difference overall in the pain scores between treatments in both groups. The handgrip strength was better in patients who used the AFB than in those who had a POP cast because of the free movement at the wrist joint permitted by the AFB (P < 0.05 at week 5).
Conclusion: The AFB can be used effectively in treating both manipulated and non-manipulated Colles fractures. The AFB gave better handgrip strength, perhaps due to the free movement at the wrist joint in the AFB. This feature may play a role in early rehabilitation, especially in elderly patients.