Comparison of above elbow and below elbow immobilisation for conservative treatment of distal end radius fracture in adults: A systematic review and meta-analysis of randomized clinical trials.

PURPOSE: The aim of this study was to analyze if any difference exists on the type of immobilisation (above elbow vs. below elbow) in the conservative treatment of distal end radius fractures in adults.

METHODS: The study was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses. An electronic literature search was performed up to 1st October 2021 in Medline, Embase, Ovid and Cochrane database using the search terms, "distal end radius fractures OR fracture of distal radius", "conservative treatment OR non-surgical treatment", "above elbow immobilisation" and "below elbow immobilisation". Randomized clinical trials written in English, describing outcome of distal end radius fractures in adults by conservative or non-surgical means using above elbow immobilisation or below elbow immobilisation were included and assessed according to the risk of bias assessment (RoB2) tool by Cochrane collaboration. Non-randomized clinical trials, observational studies, retrospective studies, review articles, commentaries, editorials, conference presentations, operative techniques and articles without availability of full text were excluded from this review. The meta-analysis was performed using Review Manager version 5.4.1 (The Cochrane Collaboration, Copenhagen, Denmark).

RESULTS: Six randomized clinical trials were included for quantitative review. High heterogeneity (I2 >75%) was noted among all the studies. The standard mean difference between the disability of the arm, shoulder and hand scores in both the groups was 0.52 (95% CI (-0.28)-1.32) which was statistically non-significant. There was no statistical difference in the radial height (mean difference 0.10, 95% CI (-0.91)-1.12), radial inclination (mean difference 0.5, 95% CI (-1.88)-2.87), palmar tilt (mean difference 1.06, 95% CI (-0.31)-2.43) and ulnar variance (mean difference 0.05, 95% CI (-0.74)-0.64). It was observed that shoulder pain occurred more commonly as a complication in above elbow immobilisation and the values were statistically significant (above elbow: 38/92, 41.3%; below elbow: 19/94, 20.2%).

CONCLUSION: This two-armed systematic review on the above elbow or below elbow immobilisation to be used for conservative treatment of the distal end radius fracture in adults resulted in non-significant differences in terms of functional and radiological scores among the two groups but significant increase in the complication rates in the above elbow group.