Redisplacement of reduced distal radius fractures in adults: does the type of casting play a role? The CAST study, a multicentre cluster randomized controlled trial.

Aims: It is not clear which type of casting provides the best initial treatment in adults with a distal radial fracture. Given that between 32% and 64% of adequately reduced fractures redisplace during immobilization in a cast, preventing redisplacement and a disabling malunion or secondary surgery is an aim of treatment. In this study, we investigated whether circumferential casting leads to fewer the redisplacement of fewer fractures and better one-year outcomes compared with plaster splinting. Methods: In a pragmatic, open-label, multicentre, two-period cluster-randomized superiority trial, we compared these two types of casting. Recruitment took place in ten hospitals. Eligible patients aged ≥ 18 years with a displaced distal radial fracture, which was acceptably aligned after closed reduction, were included. The primary outcome measure was the rate of redisplacement within five weeks of immobilization. Secondary outcomes were the rate of complaints relating to the cast, clinical outcomes at three months, patient-reported outcome measures (PROMs) (using the numerical rating scale (NRS), the abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Wrist/Hand Evaluation (PRWHE) scores), and adverse events such as the development of compartment syndrome during one year of follow-up. We used multivariable mixed-effects logistic regression for the analysis of the primary outcome measure. Results: The study included 420 patients. There was no significant difference between the rate of redisplacement of the fracture between the groups: 47% (n = 88) for those treated with a plaster splint and 49% (n = 90) for those treated with a circumferential cast (odds ratio 1.05 (95% confidence interval (CI) 0.65 to 1.70); p = 0.854). Patients treated in a plaster splint reported significantly more pain than those treated with a circumferential cast, during the first week of treatment (estimated mean NRS 4.7 (95% CI 4.3 to 5.1) vs 4.1 (95% CI 3.7 to 4.4); p = 0.014). The rate of complaints relating to the cast, clinical outcomes and PROMs did not differ significantly between the groups (p > 0.05). Compartment syndrome did not occur. Conclusion: Circumferential casting did not result in a significantly different rate of redisplacement of the fracture compared with the use of a plaster splint. There were comparable outcomes in both groups.

C-reactive protein and fibrinogen levels as determinants of recurrent preeclampsia: a prospective cohort study.

OBJECTIVE: Women with a history of early-onset preeclampsia have an increased risk of recurrent preeclampsia and are more prone to develop future cardiovascular disease. At present, risk factors underlying this association are not well characterized. We investigated whether the risk of recurrent preeclampsia is associated with pre-pregnancy levels of common cardiovascular and inflammatory markers. METHODS: Reproductive follow-up and cardiovascular parameters were obtained for 150 primiparae with a history of early-onset preeclampsia 6-12 months after their first delivery. Simultaneously, fasting plasma samples were collected and tested for lipids, glucose, C-reactive protein and fibrinogen. The relative contribution of each marker to the recurrence risk of preeclampsia and preterm delivery was estimated by Cox proportional hazard models. RESULTS: Forty-two women (28%) developed preeclampsia in a next pregnancy. Recurrent preeclampsia was related to elevated pre-pregnancy levels of C-reactive protein and fibrinogen when compared to women who did not develop recurrent disease. We found no associations between recurrent preeclampsia and maternal age, pre-pregnancy BMI, smoking or fasting levels of total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, triglycerides and glucose. CONCLUSION: These observations support a role for inflammation in recurrent hypertensive disorders of pregnancy similar to its contribution to later-life atherosclerosis and risk of cardiovascular disease.