Purpose
Nonsurgical distal radius fracture treatment requires immobilization and classical
teaching suggests varying cast positions. We investigated the effect of cast position
on the force and pressure experienced by the articular cartilage in the scaphoid and
lunate fossae.
Methods
Ten fresh-frozen cadaveric specimens were used. A standardized extra-articular distal
radius fracture was made. Force sensors were affixed to the articular cartilage of
the scaphoid and lunate fossae. Baseline data were obtained. Specimens were then placed
into a short arm cast with the wrist either neutrally aligned or flexed and ulnarly
deviated (FUD). Specimens had a standard load applied, and a force profile was obtained.
The cast was removed and the other cast type was placed and measurements were repeated.
Overall force and pressure values were compared between baseline data and the 2 cast
types. Additionally, differences in volar and dorsal scaphoid and lunate fossa forces
and pressures were compared pairwise within the 2 cast types. The relative force and
pressure values across cast types were also compared.
Results
Both cast types significantly reduced the median force and pressure experienced by
the radiocarpal joint compared with no cast. In the FUD cast, the volar and dorsal
lunate fossa experienced significantly greater force, and the dorsal lunate fossa
experienced significantly greater pressure compared with the dorsal scaphoid fossa.
There were no differences for any fossae in the neutral cast. When comparing between
casts, the volar lunate fossa experienced a significantly greater relative force in
the FUD cast compared with the neutral cast.
Conclusions
Casting a distal radius fracture decreases the forces and pressures in the radiocarpal
joint. Placing the wrist in a FUD position results in greater forces and pressures
on the lunate fossa compared with the scaphoid fossa.
Clinical relevance
When immobilization is needed, we advocate for the placement of patients in a relatively
neutral short-arm cast with minimal FUD to avoid this increased pressure.
Key words
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Article info
Publication history
Published online: July 21, 2021
Accepted:
June 16,
2021
Received:
April 1,
2020
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
