[Effect of groove splint fixation on early swelling and blood flow velocity of the injury limb in elderly patients with distal radius fractures].

Objective: To observe the effects of groove splint fixation on early hand swelling, blood flow velocity, and clinical function in elderly patients with distal radius fractures.

Methods: Between March 2021 and February 2022, 64 patients of unilateral closed distal radius fractures were treated with manual reduction and external fixation with splints. There were 10 males and 54 females, the age ranged from 60 to 78 years old, with an average age of (67.7±4.7) years old. According to the order of admission, the patients were divided into the groove splint group and the conventional splint group, with 32 cases in each group. In the groove splint group, there were 4 males and 28 females, with an average age of (68.6±4.8) years old. There were 13 patients with left-sided fractures, and 19 patients with right-sided fractures, with 22 cases classified as AO type A and 10 cases as AO type C. The mean time from injury to treatment was 3.0 (2.0, 4.0) h. In the conventional splint group, there were 6 males and 26 females, with an average age of (66.9 ± 4.4) years old. There were 17 patients with left-sided fractures and 15 patients with right-sided fractures, with 20 cases classified as AO type A and 12 cases as AO type C. The mean time from injury to treatment was 3.0 (2.0, 5.0) h. After manual reduction, patients were treated with groove splint or conventional splint. Swelling, assessed by the difference in limb circumference between the injured and healthy limbs, was measured at 1, 3, 7, and 14 days post-treatment. Blood flow velocities in the superficial palmar arch and dorsal metacarpal veins were measured at 1, 3, and 7 days post-treatment. Radiographic evaluations of radial styloid height, palmar tilt, and ulnar variance were performed preoperatively and 3 months post-treatment. Functional outcomes were assessed using the DASH (Disabilities of the Arm, Shoulder, and Hand) score 3 and 12 months post-treatment. Statistical analyses were conducted to compare the outcomes between the two groups.

Results: All 64 patients were followed up for the least 12 months. The swelling value of the palm in the groove splint group [(1.897±0.071) cm, (1.200±0.169) cm, (0.994±0.085) cm] was significantly improved compared to the conventional splint group[(2.283±0.268) cm, (1.893±0.269) cm, (1.183±0.126) cm] on days 3, 7, and 14 days posttreatment, with a statistically significant difference (P<0.001). On the first and third day after splint fixation, the difference in blood flow velocity of the superficial palmar arch in the groove splint group(0.017±0.009), (0.018±0.011) L·min-1 were lower than that in the conventional splint group(0.023±0.011), (0.025±0.013) L·min-1, with statistical significance (P<0.05). On the 3rd and 7th days, the difference was not statistically significant (P>0.05). Comparison of blood flow velocity differences between the dorsal metacarpal vein and the two groups showed no statistically significant difference on the first day after splint fixation (P>0.05). On the 3rd and 7th days, the blood flow velocity difference between the groove splint group[(0.037±0.019), (0.021±0.013) L·min-1] decreased compared to the conventional splint group[(0.062±0.033), (0.037±0.022) L·min-1], and the difference was statistically significant (P<0.05). There was no statistically significant difference in the palm angle, ulnar deviation angle, and radius height of the distal radius before and after reduction (P>0.05). The DASH score showed a statistically significant difference at follow-up 3-month[(6.1±2.8) scores vs (8.2±3.7) scores] , P<0.05, but no statistically significant difference at follow-up 12-month (P>0.05).

Conclusion: Fixing distal radius fractures with groove splints in the early stage can reduce the impact on the blood flow velocity of the superficial palmar arch and dorsal palmar vein, reduce venous reflux obstruction and swelling of injury limb, alleviate wrist and finger joint stiffness, and improve early clinical efficacy of the affected limb. However, it has no significant impact on clinical function one year after injury.