Functional Bracing Versus Rigid Plaster Casting for the Immobilization of Colles Fractures in Adults: A Meta-Analysis of Randomized Controlled Trials

Abstract

Rigid plaster casting and functional bracing are the 2 most commonly used methods for conservative immobilization in Colles fractures. Despite their widespread use, the optimal approach remains debated. A systematic literature search was conducted across PubMed, Scopus, Cochrane Library, and Google Scholar up to April 2025. Six randomized controlled trials involving 697 adult patients were included. Assessed outcomes included Visual Analogue Scale pain scores, modified Gartland and Werley functional scores, grip strength measured as a percentage of the uninjured side, modified Lidström anatomical scores, dorsal angulation, and complication rates including re-manipulation, nerve injury, complex regional pain syndrome (CRPS), upper limb dystrophy, swelling, and other adverse events. Pain scores were similar between groups at 2 and 6 weeks. Functional outcomes favored the bracing group, with significantly better scores at 12 weeks, and grip strength was also higher at 6 weeks. Bracing was associated with significantly better anatomical outcomes, as evidenced by lower dorsal angulation and better modified Lidström scores at 6 weeks, along with similar re-manipulation rates between 1 and 2 weeks post-treatment. Complication rates, including nerve injuries, CRPS, and upper limb dystrophy, were also similar between groups, with the exception of a higher incidence of hand and finger swelling in the bracing group. Taken together, functional bracing offers modest but clinically relevant advantages over plaster casting in conservatively managing Colles fractures, promoting earlier recovery and better alignment without added risk. These findings support its use in selected adults.