Report by N Greville Farrar, Senior House Officer

Search checked by Shafic Said Al-Nammari, Registrar and Craig Ferguson, Registrar

Institution: Leicester Royal Infirmary/University of Leicester, Leicester, UK; The Royal London Hospital, London, UK; Manchester Royal Infirmary, Manchester, UK

A shortcut review was carried out to establish which of a dorsal or radial backslab application was associated with the lowest rate of revision after Colles’ fracture reduction. A total of 105 papers was found using the reported searches of which none presented any evidence to answer the clinical question. It is concluded that there is no evidence to determine which of a dorsal or radial backslab should be used in this circumstance. Local advice should be followed.

Three-part question

After fracture reduction in [a patient with a Colles’ fracture] does [a dorsal or radial backslab] minimise [the need for subsequent remanipulation or operative fixation.]

Clinical scenario

An elderly lady presents to the emergency department after a fall onto an outstretched hand, sustaining a Colles’ fracture. The fracture is manipulated and you need to apply a backslab. Many departments would use a dorsal backslab but you have seen a radial backslab used for these fractures and were impressed. Believing that the radial backslab may hold the reduction more effectively, you search the literature for an answer.

Search strategy

Medline 1966 to November week 2, 2007 using the OVID interface. Embase 1980 to 2006 Week 33 using the OVID interface Medline: (exp Colles’ Fracture OR colles$.mp) AND [(exp Casts, Surgical OR back adj slab$ OR cast or casts.mp) AND exp Immobilisation] LIMIT to humans and English language. Limit to clinical trial or controlled clinical trial or meta-analysis or multicentre study or randomised controlled trial or “review” or validation studies. Embase 1980 to 2008 week 01: (colles$.mp OR exp colles fracture) AND (back adj slab$.mp OR backslab$.mp OR cast or casts.mp OR exp Plaster Cast/or exp Immobilisation) LIMIT to human and English language. LIMIT to Review or Meta Analysis or (guideline$ or protocol$ or pathway$ or algorithm$).mp or exp clinical study/or exp clinical trial or rct.mp.

LIMIT to human and English language AND Meta Analysis.mp. or (guideline$ or protocol$ or pathway$ or algorithm$).mp or exp controlled clinical trial/or rct.mp.

The Cochrane Library Issue 4 2007: MeSH descriptor Colles’ Fracture explode all trees.

Search outcome

There were 63 papers from Medline and 105 from Embase. There was one relevant Cochrane review but this did not address the question posed.

Relevant paper

No relevant papers given.

Comment

There is no literature to support a preference for using either a dorsal or a radial backslab in the management of Colles’ fractures. A radial backslab may have a theoretical advantage, as it allows three-point moulding to help prevent dorsal displacement and angulation. A randomised controlled trial may be warranted, given the significant healthcare burden resulting from Colles’ fractures, which may be reduced by maximising the effectiveness of non-operative management.