Comparison of different splints for post-operative distal radius fractures in non-injured subjects

Henry Gerard Calleja, Jessica Anne Gandionco. MD

Background: Distal radius fractures are one of the most common fractures encountered by orthopedic trauma surgeons. Treatment options range from conservative to surgical fixation, depending on the characteristics of the fracture. Although common, there is little evidence to support one method of surgical fixation over another. Furthermore, there is no consensus as to which method of immobilization is superior over the other. This study aims to compare wrist and forearm range of motion after the application of radial slab, ulnar-based forearm splint, volar splint, and long arm posterior mold in healthy adults and to evaluate these in terms of satisfaction.

Methods: Ten healthy subjects without previous injury to the dominant upper extremity were included in the study. Active wrist and forearm range of motion of the dominant extremity was measured by a single examiner using a goniometer. The following splints: radial slab, ulnar-based forearm splint, volar splint, and long arm posterior mold, were applied by the researcher in a randomized order. The subjects wore these for one hour. Range of motion was again measured with each type of immobilization, and the subjects completed the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire  (QuickDASH). The subjects were also asked to rate the different splints from 1 to 4, 1 being the splint that they preferred the most.

Results: Ten adults with a mean age of 27 (range 23 to 32), equal gender distribution (gender ratio 1:1), and majority of whom were right-handed (9:1) were included in the study. A significant difference in flexion and extension was observed in all types of splint compared with no immobilization. A significant decrease from baseline range of motion was also observed among the radial slab for radial deviation; radial slab, ulnar-based forearm splint, and long arm posterior mold for ulnar deviation; radial slab, ulnar-based forearm splint, and long arm posterior mold for pronation; and long arm posterior mold for supination. There was no significant difference between mean QuickDASH scores of the radial slab, ulnar-based forearm splint, and volar splint compared with each other; however, a significant difference was found with these three when compared to the long arm posterior mold (p = 0.039, p = 0.003, p < 0.001, respectively). There was a significant difference in the perception of patient ranking per splint (chi-square with three degrees of freedom = 11.640, p = 0.009) with the volar splint ranking the highest.

Conclusion: The long arm posterior mold provided the overall greatest restraint to range of motion compared with the other types of splints, especially in pronation and supination. The volar splint had significantly better functional scores and subjective perception, but provided the least amount of restriction. For a balance between good decrease in range of motion as well as better tolerance, the ulnar-based forearm splint can be used.