Immobilization Time for Conservative Treatment of Distal Radial Fractures in Elderly Patients

Background: The management of distal radial fractures (DRFs) in elderly patients remains controversial. Although conservative treatment with cast immobilization is widely accepted, the optimal duration for immobilization is unclear. This study aimed to compare pain control, functional outcomes, and complication rates between 4-week and 6-week immobilization periods in elderly patients treated nonoperatively for displaced DRFs. Methods: A single-center randomized controlled trial was conducted, including 150 patients who were ≥65 years of age and had displaced DRFs. Patients were randomized into 2 groups: 4-week immobilization and 6-week immobilization. Pain was assessed using a visual analog scale (VAS) at 10 days after removing the cast and then at 3, 6, and 12 months after injury. Functional outcomes were measured using the Patient-Rated Wrist Evaluation (PRWE) and QuickDASH (the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire) at 3, 6, and 12 months. Radiographs were reviewed for malunion, and complications and range of motion were also evaluated. Results: In the 135 patients analyzed, no differences were observed in pain or functional outcomes between the 2 groups at any time point. VAS scores 10 days after the cast removal were similar (3.87 for the 4-week immobilization group and 4.00 for the 6-week group; p = 0.67), as were PRWE scores (14.18 for the 4-week group and 15.51 for the 6-week group; p = 0.686) and QuickDASH scores (15.46 for the 4-week group and 17.86 for the 6-week group; p = 0.449) after 1 year. The malunion rates were 29.9% in the 4-week group and 32.8% in the 6-week group (p = 0.85), and there were no significant differences in complications or range of motion between groups. Conclusions: A 4-week immobilization period provided equivalent pain control, functional outcomes, and complication rates as a 6-week immobilization period in elderly patients with displaced DRFs treated nonoperatively. Therefore, a shorter immobilization period may be safely recommended for treating these fractures. Level of Evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.