Below-Elbow Versus Initial Above-Elbow Casting for Distal Radius Fractures

NCT07704879 | Completed

• 1 other identifier: 2020/882
• Study Type: interventional
• Target: 93
• Locations: 1 country
• Sites: 1

Brief Summary

The goal of this clinical trial was to compare two casting strategies for adults with a broken wrist, also called a distal radius fracture. The study included people whose treating team had determined that treatment without surgery was appropriate. Their fracture was first put back into position without surgery. The main questions were:

• Does starting treatment with a below-elbow cast or an above-elbow cast affect how well the fracture stays in position?
• Does cast length affect early elbow or shoulder pain and stiffness?
• Does it affect grip strength, arm and wrist muscle recovery, wrist function, or long-term disability? Researchers compared a below-elbow cast used from the start with an above-elbow cast used for the first 2 weeks and then changed to a below-elbow cast. Participants:
• were randomly assigned to one of the two casting strategies
• wore a cast for 4 weeks, followed by a splint and rehabilitation
• had x-rays and clinical assessments during the first 12 weeks
• were scheduled for bilateral grip-strength and machine-based muscle-strength testing at cast removal and at 12 weeks
• were invited to complete a clinical and functional follow-up assessment at approximately 5 years

Conditions

Distal Radius Fracture

Keywords

Below-elbow cast; Initial above-elbow cast; Short-arm cast; Long-arm cast; Closed reduction; Cast immobilization; Nonoperative treatment; Isokinetic dynamometry; Grip strength; Reduction loss; Five-year follow-up; Wrist fracture

Outcome Measures

Primary Outcomes (1)

• Isokinetic Peak Torque Normalized to Body Weight at 12 Weeks

  Peak torque measured by bilateral Cybex isokinetic dynamometry was normalized to body weight and expressed as a percentage for elbow flexion, elbow extension, wrist flexion, wrist extension, forearm supination, and forearm pronation. Values were recorded separately for the affected and unaffected upper extremities. Higher values indicate greater strength relative to body weight.

  12 weeks after closed reduction

Secondary Outcomes (27)

• Raw Isokinetic Peak Torque at Cast Removal

  At cast removal, 4 weeks after closed reduction

• Raw Isokinetic Peak Torque at 12 Weeks

  12 weeks after closed reduction

• Isokinetic Peak Torque Normalized to Body Weight at Cast Removal

  At cast removal, 4 weeks after closed reduction

• Raw Isokinetic Work per Repetition at Cast Removal

  At cast removal, 4 weeks after closed reduction

• Isokinetic Work per Repetition Normalized to Body Weight at Cast Removal

  At cast removal, 4 weeks after closed reduction

Other Outcomes (6)

• Contralateral Raw Isokinetic Peak Torque at the Initial Injury Assessment

  At the initial injury assessment (Day 1)

• Contralateral Isokinetic Peak Torque Normalized to Body Weight at the Initial Injury Assessment

  At the initial injury assessment (Day 1)

• Contralateral Raw Isokinetic Work per Repetition at the Initial Injury Assessment

  At the initial injury assessment (Day 1)

Study Arms (2)

Below-Elbow Cast

EXPERIMENTAL

After nonoperative treatment was determined to be appropriate and closed reduction was completed, participants received a below-elbow cast. Cast immobilization continued for 4 weeks, after which the cast was removed and splinting and rehabilitation were started.

Procedure: Below-Elbow Cast Immobilization

Initial Above-Elbow Cast

ACTIVE COMPARATOR

After nonoperative treatment was determined to be appropriate and closed reduction was completed, participants received an above-elbow cast. At 2 weeks, the cast was converted to a below-elbow cast. All cast immobilization ended at 4 weeks, followed by splinting and rehabilitation.

Procedure: Initial Above-Elbow Cast Followed by Below-Elbow Cast

Interventions

Below-Elbow Cast Immobilization PROCEDURE

A below-elbow cast was applied following closed reduction of the distal radius fracture. The cast was maintained until 4 weeks after reduction and was then removed. Splinting and rehabilitation followed cast removal.

Also known as: Short-Arm Cast Immobilization

Below-Elbow Cast

Initial Above-Elbow Cast Followed by Below-Elbow Cast PROCEDURE

An above-elbow cast was applied following closed reduction of the distal radius fracture. At 2 weeks, the above-elbow cast was converted to a below-elbow cast. All cast immobilization ended at 4 weeks after reduction, followed by splinting and rehabilitation.

Also known as: Initial Long-Arm Cast Followed by Short-Arm Cast

Initial Above-Elbow Cast

Eligibility Criteria

• Age: 18 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18 to 70 years
• Closed distal radius fracture for which the treating team determined that nonsurgical treatment with closed reduction and cast immobilization was appropriate
• AO/OTA distal radius fracture classified as 2R3A2, 2R3A3, 2R3B2, 2R3B3, 2R3C1, 2R3C2, or 2R3C3

You may not qualify if:

• AO/OTA distal radius fracture classified as 2R3A1 or 2R3B1
• Open distal radius fracture
• History of an allergic reaction to cast material
• Previous surgery involving the wrist or elbow
• Distal radius fracture judged to require operative treatment at the initial evaluation

Sponsors & Collaborators

• Istanbul University: lead

Study Sites (1)

Istanbul University, Istanbul Faculty of Medicine, Department of Orthopedics and Traumatology

Istanbul, 34093, Turkey (Türkiye)

Location

Related Publications (5)

• Chaudhry YP, Morway GR, Papadelis EA, Doerr NA, Graf KW, Mashru RP, Dolch HJ. Comparison of Short-Arm Immobilization and Long-Arm Immobilization in Conservatively Managed Distal Radius Fractures: A Meta-Analysis and Systematic Review. Cureus. 2024 Mar 8;16(3):e55813. doi: 10.7759/cureus.55813. eCollection 2024 Mar.

  PMID: 38590464 BACKGROUND

• Okamura A, de Moraes VY, Neto JR, Tamaoki MJ, Faloppa F, Belloti JC. No benefit for elbow blocking on conservative treatment of distal radius fractures: A 6-month randomized controlled trial. PLoS One. 2021 Jun 10;16(6):e0252667. doi: 10.1371/journal.pone.0252667. eCollection 2021.

  PMID: 34111160 BACKGROUND

• Caruso G, Tonon F, Gildone A, Andreotti M, Altavilla R, Valentini A, Valpiani G, Massari L. Below-elbow or above-elbow cast for conservative treatment of extra-articular distal radius fractures with dorsal displacement: a prospective randomized trial. J Orthop Surg Res. 2019 Dec 30;14(1):477. doi: 10.1186/s13018-019-1530-1.

  PMID: 31888682 BACKGROUND

• 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.

  PMID: 36189333 BACKGROUND

• Park MJ, Kim JP, Lee HI, Lim TK, Jung HS, Lee JS. Is a short arm cast appropriate for stable distal radius fractures in patients older than 55 years? A randomized prospective multicentre study. J Hand Surg Eur Vol. 2017 Jun;42(5):487-492. doi: 10.1177/1753193417690464. Epub 2017 Mar 1.

  PMID: 28490225 BACKGROUND

MeSH Terms

Conditions

Wrist Fractures

Condition Hierarchy (Ancestors)

Wrist Injuries; Arm Injuries; Wounds and Injuries; Fractures, Bone

Study Officials

• Alper Ş. Kendirci, M.D.

  Istanbul University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor of Orthopaedics and Traumatology

Model Details: After the treating team established that nonoperative treatment was appropriate, participants underwent closed reduction and were randomized in parallel to below-elbow casting or initial above-elbow casting. In the initial above-elbow casting group, the cast was converted to a below-elbow cast at 2 weeks. Cast immobilization ended at 4 weeks in both groups, followed by splinting and rehabilitation.

Study Record Dates

• First Submitted: July 11, 2026
• First Posted: July 15, 2026
• Study Start: July 2, 2020
• Primary Completion: June 20, 2022
• Study Completion: June 14, 2026
• Last Updated: July 15, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)