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Three Part Question

Following fracture reduction in [a patient with a Colles' fracture] does [a dorsal or radial backslab] minimize [the need for subsequent remanipulation or operative fixation.]

Clinical Scenario

An elderly lady presents to the emergency department following 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
The Cochrane Library Issue 4 2007
Medline::[(exp Colles' Fracture OR colles$.mp)] AND [(exp Casts, Surgical OR back adj slab$ OR cast or casts.mp) AND exp Immobilization] LIMIT to humans and english language. Limit to clinical trial or controlled clinical trial or meta analysis or multicenter study or randomized controlled trial or 'review' or validation studies.
Embase: (colles$.mp OR exp colles fracture) AND (back adj slab$.mp OR backslab$.mp OR cast or casts.mp OR exp Plaster Cast/or exp Immobilization) LIMIT to human and english language. LIMIT to Review or Meta Analysis or (guideline$ 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
Cochrane: 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.

Comment(s)

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, whcih may be reduced by maximising the effectiveness of non-operative management.

Clinical Bottom Line

There is no evidence to determine whether a dorsal or radial backslab should be used to hold Colles' fractures. Local advice should be followed.