Efficacy of cast immobilization versus surgical treatment for distal radius fractures in adults: a systematic review and meta-analysis

SUMMARY: This articl e includes high-quality randomized controlled trials in recent years and updates the past meta-analysis. It has been proved that cast immobilization can achieve similar functional results, reduce economic burden in the long-term compared with surgery, and provide a basis for doctors to make treatment choices. PURPOSE: The efficacy of conservative and surgical treatment of distal radius fractures (DRFs) in adults is still controversial. Recently, some high-quality randomized controlled trials (RCTs) evaluated the efficacy of both treatments. We hypothesized that treatment of DRFs with closed reduction and cast immobilization would achieve functional outcomes similar to surgery. METHODS: This study is a systematic review and summary of RCTs comparing conservative and surgical management of DRFs from 2005 to March 2022. Patients were evaluated for functional and imaging outcomes and complications. RESULTS: A total of 11 studies [1–11] included 1775 cases of DRFs. At 1-year follow-up, the cast group had lower mean differences (MDs) in DASH scores than the surgery group by − 2.55 (95% CI = − 5.02 to − 0.09, P = 0.04); with an MD of 1.63 (95% CI = 1.08–2.45, P = 0.02), while the surgery group had a lesser complication rate than the cast group. CONCLUSIONS: At 1-year follow-up, the lower DASH scores of the cast group showed advantages of this treatment, but the complication rate was higher than that of the surgery group. There was no massive distinction in other scoring methods. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00198-022-06649-8.