title: Circumferential Casting of Distal Radius Fractures.
abstract: OBJECTIVE
  To determine the prevalence and predictive factors for the early cast alteration (splitting, trimming, and complete replacement) in patients with distal radius fractures (DRFs) treated in circumferential cast. To determine whether performing early cast alterations affects the fracture alignment.
  
  
  METHODS
  Retrospective Cohort Study.
  
  
  METHODS
  Level 1 Trauma Center.
  
  
  METHODS
  All adult patients who presented with a DRF to a tertiary care hospital over a 3-year period.
  
  
  METHODS
  All DRFs without immediate surgical indications are initially treated with circumferential casts at this center.
  
  
  METHODS
  The following variables were analyzed: patient demographics, polytrauma at the time of injury, physician subspecialty performing reduction, and type of cast alteration. Radiographs were used to assess initial fracture characteristics and secondary displacement of reduction over time. Analysis was performed primarily to identify predictive variables for the early cast alteration and secondarily to determine the effect of these alterations on fracture alignment.
  
  
  RESULTS
  296 patients were included in the study. One of every 4-5 patients had their cast altered within the first 10 days of treatment. One of 3 polytrauma patients had their cast altered. No type of cast alteration was found to be significantly predictive of loss of fracture alignment at 2 or 6 weeks.
  
  
  CONCLUSIONS
  Cast alteration is commonplace after casting of DRFs but is not associated with the loss of alignment. Patients with polytrauma may benefit from immediate cast splitting.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Division of Orthopedic Surgery, McGill University Health Center, Montreal General Hospital, Montreal, Canada; and †Faculty of Medicine, McGill University, Montreal, Canada.
authors.forename: Justin
authors.initials: J
authors.lastname: Drager
authors.forename: Alberto
authors.initials: A
authors.lastname: Carli
authors.forename: Bogdan A
authors.initials: BA
authors.lastname: Matache
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Berry
authors.forename: Rudy
authors.initials: R
authors.lastname: Reindl
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Harvey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017760:Bone Malalignment / Q000209:etiology / Q000517:prevention & control; D002370:Casts, Surgical / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011885:Radius Fractures / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult