Abstract
Introduction Closed reduction and cast immobilization is a common practice as initial treatment
for distal radius fractures. This study examines the pain perception that accompanies
this approach.
Materials and Methods Thirty dorsally displaced distal radius fractures were reduced and casted under finger-trap
traction with intravenous analgesics. Patients rated their pain perception on visual
analog scale prior to presentation, during reduction, during casting, and for every
day until surgery. Closed reduction improved palmar tilt from −26.3 to −10.8 degrees.
Surgery improved palmar tilt from −10.8 to +6.1 degrees. Closed reduction improved
radial inclination from 15.5 to 19.1 degrees. Surgery improved radial inclination
from 19.1 to 21.6 degrees. Mean pain perception was 5.8 at presentation. Reduction
increased pain to 7.5 (p < 0.001), whereas casting was less painful (3.7; p < 0.001). At the evening following casting and the following days until surgery,
mean pain was still as high as 4.1, 4.2, 4.1, 3.6, 3.9, 2.8, 3.0, and 3.0, with some
patients experiencing more pain than initially.
Conclusion Reduction generates significant pain with only minor relief during cast immobilization.
The indication for closed reduction prior to cast application is therefore questionable.
Keywords
cast immobilization - closed reduction - Colles’ fractures - complex regional pain
syndrome - distal radius fracture - pain perception
