{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:43:00Z","timestamp":1775644980093,"version":"3.50.1"},"reference-count":59,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T00:00:00Z","timestamp":1623283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2019\/04546-4"],"award-info":[{"award-number":["2019\/04546-4"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>For displaced distal radius fracture, this trial aimed to compare an above-elbow (AE) and below-elbow (BE) cast at the end of a 24-week follow-up using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire as a primary outcome.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This is a clinical trial with parallel groups (1:1) and a blinded evaluator. There are two non-surgical interventions: AE and BE. A total of 128 adult patients with acute (up to 7 days) displaced distal radius fracture of type A2-3, C1-3 by the AO classification were included. The follow-up was 24 weeks. The primary outcome was the DASH questionnaire at 24 weeks. Secondary outcomes were the maintenance of reduction by the evaluation of radiographic parameters, pain measured by VAS, PRWE, objective functional evaluation and rate of adverse effects.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The difference between the two groups in the DASH score at 24 weeks was not significant, with the mean (95% CI) DASH score being AE: 9.44 (2.70 to 16.17) vs. BE: 9.88 (3.19 to 16.57) (p = 0.895). The above-elbow group had a significantly greater worsening of the mean DASH score from baseline to 2 weeks (p &lt; 0.001). No statistically significant differences were found between the 2 groups in any of the other follow-up assessments. Objective functional evaluation, PRWE, radiographical measures and rates of reduction loss were similar between groups. Above-elbow casting resulted in more adverse effects (mostly shoulder pain; 19 events vs. 9 events); RR = 0.39 (0.19\u20130.94); p = 0.033 at the end of six-month follow-up.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This study did not demonstrate a difference between above-elbow and below-elbow cast in terms of DASH outcome at 6 months in non-surgical treatment of deviated distal radius fractures. However, below-elbow casting is less debilitating during the treatment period, has comparable performance in maintaining the reduction, and is related to fewer minor adverse effects than above-elbow casting.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0252667","type":"journal-article","created":{"date-parts":[[2021,6,10]],"date-time":"2021-06-10T23:55:46Z","timestamp":1623369346000},"page":"e0252667","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":14,"title":["No benefit for elbow blocking on conservative treatment of distal radius fractures: A 6-month randomized controlled trial"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0115-2236","authenticated-orcid":true,"given":"Aldo","family":"Okamura","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vin\u00edcius Ynoe","family":"de Moraes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge Raduan","family":"Neto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcel Jun","family":"Tamaoki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flavio","family":"Faloppa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u00e3o Carlos","family":"Belloti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,6,10]]},"reference":[{"key":"pone.0252667.ref001","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1053\/jhsu.2001.26322","article-title":"The frequency and epidemiology of hand and forearm fractures in the United States","volume":"26","author":"KC Chung","year":"2001","journal-title":"J Hand Surg Am"},{"key":"pone.0252667.ref002","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1007\/s00264-011-1300-0","article-title":"Internal versus external fixation for unstable distal radius fractures: an up-to-date meta-analysis","volume":"35","author":"Z Cui","year":"2011","journal-title":"Int Orthop"},{"key":"pone.0252667.ref003","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1016\/j.jhsa.2011.02.005","article-title":"A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly","volume":"36","author":"RJ Diaz-Garcia","year":"2011","journal-title":"J Hand Surg Am"},{"key":"pone.0252667.ref004","first-page":"CD000314","article-title":"Conservative interventions for treating distal radial fractures in adults","volume":"2","author":"H Handoll","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"pone.0252667.ref005","doi-asserted-by":"crossref","first-page":"e0206895","DOI":"10.1371\/journal.pone.0206895","article-title":"A systematic review of the quality of distal radius systematic reviews: methodology and reporting assessment","volume":"14","author":"JC Belloti","year":"2019","journal-title":"PLoS One"},{"issue":"3","key":"pone.0252667.ref006","doi-asserted-by":"crossref","first-page":"180","DOI":"10.5435\/00124635-201003000-00007","article-title":"Treatment of distal radius fracture","volume":"18","author":"DM Lichtman","year":"2010","journal-title":"J Am Acad Orthop Surg"},{"issue":"5","key":"pone.0252667.ref007","doi-asserted-by":"crossref","first-page":"e0232153","DOI":"10.1371\/journal.pone.0232153","article-title":"Two casting methods compared in patients with Colles\u2019 fracture: a pragmatic, randomized controlled trial","volume":"15","author":"L Raittio","year":"2020","journal-title":"PLoS One"},{"issue":"1","key":"pone.0252667.ref008","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1302\/0301-620X.102B1.BJJ-2019-0243.R2","article-title":"Woodcast versus standard casting material for the immobilization of nonoperatively treated distal radial fractures","volume":"102-B","author":"S Gwilym","year":"2020","journal-title":"Bone Joint J"},{"key":"pone.0252667.ref009","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1302\/0301-620X.55B3.540","article-title":"Colles\u2019s fracture. 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