• Eva Anna Klazina van Delft, Tamara Geertruda van Gelder, Jefrey Vermeulen, Niels Willem Luitzen Schep, and Frank Willen Bloemers.
• Department of Trauma Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam Movement Sciences, Boelelaan 1117, Postbox 7057, 1007 MB, Amsterdam, The Netherlands. evavandelft@gmail.com.
• Eur J Trauma Emerg Surg. 2022 Jun 1; 48 (3): 1751-1757.

PurposeThe position of the wrist during cast immobilisation following closed reduction of distal radius fractures is disputed. A systematic review was initiated to assess if there was any relation between wrist position in the cast and outcome in adult patients with non-operatively treated distal radius fractures.MethodsA comprehensive search was performed in the bibliographic databases Medline, Embase and Wiley/Cochrane Library from inception up to 27 November 2020. Eligible studies were: randomised controlled trials, prospective and retrospective comparative cohort studies, analysing different positions of the wrist in cast-immobilisation following closed reduction. Primary outcome of the study was functional outcome measured by range of motion. Secondary outcomes were functional outcomes measured by grip strength, patient-reported outcome, radiological outcome and complications such as secondary dislocation and pain.ResultsThe initial search yielded 2733 studies. Five trials, with 519 patients, were included in this systematic review. Range of motion and radiological outcome was significantly better in patients who were immobilised in dorsiflexion compared to palmar flexion or neutral position, although no clinical important difference was found. There were no significant differences in patient-reported outcome, pain, grip strength or complications. Due to heterogeneity of the included studies, data were unsuitable for a meta-analysis.ConclusionThis systematic review showed statistically significant better results in favour of cast immobilisation in dorsiflexion, although this small difference does not seem to be relevant in patients daily activities.Systematic Review Registration NumberSystematic review registration number: PROSPERO 2018 CRD42018085546.© 2021. The Author(s).

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