CoNCReTe-trial: Colles Fractures, Determining the Norm in Closed Reduction Techniques

Rijnstate Hospital

Status

Terminated

Conditions

Colles' Fracture

Treatments

Procedure: Finger Trap Traction

Procedure: Manual Manipulation

Study type

Interventional

Funder types

Other

Identifiers

NCT00631267

LTC-502-141207

Details and patient eligibility

About

Rationale:

Many different closed techniques are used to reduce a dorsally dislocated distal radius fracture (Colles' fracture). One trial to compare two main techniques (finger-trap traction and manual manipulation) did not find significant difference in radiological and clinical outcome (Earnshaw 2002). This trial aims to investigate patient and medical satisfaction between both techniques

Objective:

To demonstrate patient satisfaction (pain, duration, general) and medical satisfaction (difficulty of reposition). It is suggested that finger-trap traction causes less pain for patients and is more easy than manual manipulation but have the same radiological and clinical outcome.

Study design:

Randomised controlled intervention study

Study population:

300 Patients with newly diagnosed closed distal radius fractures with dorsal angulation (Colles' fracture) older than 16years coming to the Emergency Medical Department.

Intervention:

One group is put in finger-trap traction (digitus 1-3) for 10minutes with 4-5kg of ballast on their upper arm followed by reduction by dorsal pressure. The other group is manually reduced according to Charnley with traction and "hooking over" of the fracture elements.

Main study parameters/endpoints:

Visual analogue scale of patient and medical satisfaction, percentage of successful primary reductions. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: Apart for the regular follow-up of patients with distal radius fractures,one extra out-patient visit is necessary to assess functional outcome after three months.Finger-trap traction has a (theoretical) risk of causing traumatic damage to ligaments of the fingers, but this risk is in our opinion not higher than in the manual manipulation. It is expected that the finger-trap traction group is more satisfied because this technique seems less traumatic than but as successful as the manual manipulation group.

Enrollment

98 patients

Sex

All

Ages

16+ years old

Volunteers

Accepts Healthy Volunteers

Inclusion criteria

Patients of 16 years and older visiting our EMD with newly diagnosed closed distal radius fractures:

within 2cm of the radiocarpal joint
with dorsoradial dislocation (Colles' fractures),
AO-type 23.A2 and 23.A3 (extra-articular) and 23-C1 and 23-C2 (intra-articular)
which are in need for reduction. I.e. Colles' fractures:
- with loss of ≥2mm of radial height (RH),
- change of ≥5º of radial inclination (RI),
- loss of ≥10º volar tilt (VT),
- loss of reduction of the distal radioulnar (DRU) joint and/or
- fractures with >1mm intra-articular step-off

Exclusion criteria

Patients who will not have their follow-up in our hospital
Patients <16 year old
Greenstick fractures
Additional fractures of carpalia or elbow joint
Patients suffering a High Energy Trauma (HET)
Fractures that do not need reduction (see 4.2 for definition)
Patients with pre-existent wrist-trauma or pathological bone except for osteoporosis (cyst, metastasis)
Patients who cannot give informed consent or do not understand the Dutch language
Patients with bilateral fractures
Open fractures
Fractures >48h old
(Smith, Barton, reversed Barton or Chauffeurs fractures)