Reachout Orthopedics - Issue 1

Etoricoxib Beneficial for Pain Relief, and Joint Function in Osteoarthritis Among Elderly Below- vs Above-elbow Cast for Distal Radius Fractures: Is Elbow Immobilization Really Effective for Reduction Maintenance? According to a recent study published in the Bosnian Journal of Basic Medical Sciences etoricoxib provides significant pain relief, improves joint function, quality of life and treatment satisfaction in elderly with osteoarthritis. Etoricoxib, a selective cyclooxygenase-2 inhibitor has been shown to be associated with low risk of gastrointestinal irritation in comparison to commonly used non-steroidal anti-inflammatory drugs (NSAIDs). Huang WN and colleagues assessed the efficacy and tolerability profile of etoricoxib in a cohort of elderly individuals with osteoarthritis related pain. Elderly patients (mean age 85.9 years) with inadequate response to NSAIDs were administered 60 mg etoricoxib once daily for 4 weeks. The main outcome assessed was pain improvement using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and secondary outcomes were Brief Pain Inventory Short Form (BPI-SF), Treatment Satisfaction Questionnaire for Medication (TSQM), Short Form 36 (SF36), and European Quality of Life-5 Dimensions (EQ-5D). Adverse event reports were used to evaluate the tolerability. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) index score used to measure pain and disability showed reduction after treatment with etoricoxib. Improvement in joint function during walking and performing normal work was also recorded using BPI-SF. Significant improvement in 7 out of 11 domains of SF36 was evident after treatment. Overall patient satisfaction was also observed. There were no adverse events with the therapy. It was concluded that etoricoxib is useful in improving pain, joint function, quality of life and treatment satisfaction in elderly with osteoarthritis. Source: Huang WN, Tso TK. Etoricoxib improves osteoarthritis pain relief, joint function, and quality of life in the extreme elderly. Bosn J Basic Med Sci . 2018; 18(1):87-94. DOI 10.17305/bjbms.2017.2214. © 2018 ABMSFBIH. The choice of the cast length in conservative management of distal radius fractures still represents a debated controversy. Historically, the elbow is immobilized to reduce the risk of secondary displacement; however, short-arm casts are currently felt to be equally effective with less complications and better patient comfort. This paper investigates whether im- mobilization of the elbow is actually effec- tive in reducing the risk of loss of reduction in conservatively manipulated distal radius fractures. We retrospectively studied 297 con- secutive patients with distal radius fractures requiring manipulation and subsequently immobilized with above-elbow cast or be- low-elbow cast. Maintenance of reduction, radial height, radial inclination, and volar tilt were assessed after the reduction and at 35 days. Appropriate statistical analysis was performed to correct data selection bias and to assess any difference in the effectiveness among the two treatments. The mean difference of loss of radial height, inclination, and volar tilt between the two groups was 0.8 mm, 0.4°, and 0.9° respectively, being not statistically significant. Average difference in reduction maintenance probability between the two groups stratified with a statistical propensity score was 1.2%. Above- and below-elbow casts had comparable performance in maintaining reduction of manipulated distal radius fractures. Source: Tommaso Maluta, Giovanni Dib, Matteo Cengarle, et al . Below- vs above-elbow cast for distal radius fractures: is elbow immobilization really effective for reduction maintenance? Int Orthop. 2018 Oct 15. DOI 10.1007/ s00264-018-4197-z. © SICOT aisbl 2018. 28 Prime Time News