Short vs Long Arm Cast for Distal Radius Fractures: the Verona Trial (SLA-Ver)

Short vs Long Arm Cast for Distal Radius Fractures: the Verona Trial. Randomized Clinical Trial to Assess the Efficacy of Short Arm Cast Versus Long Arm Cast in Conservative Management of Distal Radius Fractures

This study prospectively compares the performance of an above-elbow cast (long arm cast) and a below-elbow cast (short arm cast) to maintain reduction in conservatively managed distal radius fractures.

The choice of cast length in conservative management of distal radius fractures still represents a much debated controversy. Classic teaching was to immobilize the elbow to reduce risk of secondary displacement; however, short arm casts are felt to be equally effective with less complications and higher patient comfort. There is currently no conclusive evidence for or against immobilization of the elbow in patients treated with cast immobilization.

Non-inferiority trial aimed at comparing the non inferiority of a short arm cast (below elbow cast) as opposed to a long arm cast (below elbow cast) in terms of fracture reduction maintenance ratio. The sample size was selected as the highest required to test all non-inferiority thresholds and considering a drop-out percentage of 15%. Continuous values of all radiological parameters were used in order to keep results objective and reproducible. At the end of recruitment observed drop-out percentage was 26%.

Percentage of fractures that displace during treatment as subjectively assessed on radiographs by investigators.

Difference between radial length values as objectively measured on postreduction radiographs and endtreatment radiographs.

Difference between radial inclination values as objectively measured on postreduction radiographs and endtreatment radiographs.

Difference between volar tilt vaues as objectively measured on postreduction radiographs and endtreatment radiographs.

Degrees of extension, flexion, pronation and supination of the elbow measured at the end of the treatment.

Disability of Arm, Shoulder and Hand score measured at the end of the treatment relating to patient's comfort during treatment.

Short Form 12 health questionnaire administered at the end of the treatment relating to patient's quality of life during treatment.

Inclusion Criteria: Diagnosis of distal radius fracture Indication to conservative treatment Need for manipulation to reduce fracture Exclusion Criteria: Open fractures Existence of any skin lesion or wound that would impair cast treatment Neurovascular deficits Bilateral fractures Association with any other fracture of the homolateral arm

Dib G, Maluta T, Cengarle M, Bernasconi A, Marconato G, Corain M, Magnan B. Short arm cast is as effective as long arm cast in maintaining distal radius fracture reduction: Results of the SLA-VER noninferiority trial. World J Orthop. 2022 Sep 18;13(9):802-811. doi: 10.5312/wjo.v13.i9.802. eCollection 2022 Sep 18.