Comparing Casting Without Reduction to Closed Reduction for Distal Radius Fractures in Patients 65 Years and Older A Randomized Controlled Trial Evaluating Wrist Pain and Disability Outcomes

What this Trial Is About

This research evaluates treatment methods for older adults aged 65 years or older who have displaced distal radius fractures caused by low-energy injuries. It compares casting without prior closed reduction to casting after closed reduction to see if they provide equivalent results in wrist pain and disability after 12 months. The study is a randomized controlled trial including 532 participants and led by Tampere University Hospital, focusing on the Patient-Rated Wrist Evaluation PRWE score as the primary measure. Participants are randomly assigned to one of two groups one receiving a dorsal cast without reduction right after the initial x-ray, and the other undergoing closed reduction under local anesthesia followed by casting. Both groups have their casts removed after 5 weeks and are encouraged to resume normal wrist use without restrictions. An observational group receiving standard care without randomization is also followed remotely. Follow-up visits occur at 3 and 12 months, with radiographs taken at 3 months only. Participants will attend follow-up appointments in person or remotely, completing questionnaires and wearing accelerometer wristbands if remote. Data is collected via the REDCap system. Outcomes measured include wrist function, pain, quality of life, and adverse events. Patients with ongoing symptoms may receive physiotherapy for up to one year and further evaluation if needed. A 5-year follow-up is planned as an exploratory endpoint to monitor long-term results.

No Reduction Compared to Closed Reduction for Distal Radius Fractures in Patients Over 65 or Older