Patient-Centred Fracture Treatment


Doctor Pranesh Kumar - Posted March 2022

Health care system around the world have undergone a noticeable shift from being centered around a traditional, noble-profession, to becoming a more customer-oriented, service industry (ref1). Factors contributing to this evolution within the health care system includes the growing availability and variety of information from the internet, higher levels of patient expectation, increased breadth of health insurance options, growth in competition amongst providers, and advancement in medical technology (ref1). Assessing patient satisfaction is now viewed as an effective proxy measure when assessing doctors’ and hospitals’ performance. Given these changes within health care and the universal adoption of a more ‘patient-centred’ approach to treatment, feedback from patients provides a particularly valuable perspective (ref1,2,3). Patient satisfaction measures have become increasingly important metric and the data from such assessments are impacting performance goals  of clinicians, healthcare providers, financial performance and improvements to patients’ overall well-being. 

Each patient being treated for a fracture wants the prescribed treatment to perform well, provide freedom from pain and give minimal disruption to their routine daily activities. Most patients assume that these treatment goals are fully-aligned with their prescriber’s goals, however this isn’t always the case.  Many patients are surprised and disappointed when their fracture treatment turns out to be a negative experience.

The most common method of fracture treatment is a vintage technology that was first used  over 160 years ago (traditional plaster casting). This traditional technology is known to be uncomfortable, heavy, itchy and cumbersome. It often requires several replacement casts to be fitted during treatment and may require multiple clinic visits. The clinical literature provides a number of references to the many common challenges faced by patients when treated with traditional methods (ref 4,5).  


PAPER*:   Naicker, Pregasen. “Prospective Case Study for Evaluation of Clinical Efficacy and Patient Satisfaction of a Novel Adjustable Wrist Splint for Simple Distal Radius Fracture.” J Trauma Treat 11(2022): 487.  (COPY OF FULL PAPER - LINK)

This above clinical paper* from Dr Pregasen (published Feb 2022), addresses this important topic head-on. It reports high levels of patient-satisfaction when patients are treated using a novel fracture treatment (Zero-Cast Wx for distal radius fractures).  The study notes that the desired fracture-healing outcome that is provided by Zero-Cast Wx is comparable to traditional treatments. We also note that clinical literature on the topic of fracture treatment has largely ignored reporting on levels of patient satisfaction and comfort. 

Patients who were fitted with Zero-Cast Wx in Dr Pregasen’s study* were asked to complete a self-assessment questionnaire and the results highlighted excellent scoring for patient-convenience, hygiene & comfort.  This peer reviewed, prospective clinical study, reported that patients treated with Zero-Cast Wx and measured using the Patient Rated Wrist Evaluation (PRWE) questionnaire, scored highly. The PRWE is a universally recognised and validated wrist-scoring system. Patients in this study reported particularly high scoring in 'return to function' and 'normal daily activities'. The study* notes “Being lightweight and less restrictive were added factors that played roles in eliciting positive patient feedback”.   The author summarised the Zero-Cast Wx treatment experience for the patient as “more comfortable, less limiting and hygienic”.  In addition, the paper noted the device received positive feedback from clinicians and highlighted it was “quick and easy to fit”.

A second clinical paper is discussed below**. It is from Auckland University Of Technology Bioengineering Lab and studied the water absorption and drying speed of common fracture casts compared with Zero-Cast Wx.  It showed that Zero-Cast Wx performed significantly better than the comparators and that the Zero-Cast device dried quickly (thus suggesting greater patient comfort and less opportunity for skin irritation during treatment). 

PAPER**:   White, David E. Van Wyk, Michael J “Comparison of Water Absorption and Drying in Distal Radius Fracture Casts and Orthoses.” Journal Of the AAOS Global Research & Reviews. Sept 2021, Vol5, No 9.  (LINK; Copy Of Paper Here)

The above laboratory study** has now been clinically validated by the findings of Dr Pregasen’s paper*, where it was noted that hygiene, comfort and waterproofness of Zero-Cast Wx contribute to the overall patient satisfaction experience as rated by patients undergoing treatment in this clinical study.


(Improved patient satisfaction doesn’t have to cost more)

This AUT paper** by D White & M van Wyk, includes an important reference to  treatment-cost comparisons between inexpensive (unit cost) plaster/fibre bandages and the more expensive unit-cost of the adjustable Zero-Cast Wx device. This paper highlights that using UNIT-COST as the only comparison is a severely flawed method for measuring the true cost of fracture-treatment. Citing studies (ref6), the author points to fracture treatment costs being heavily influenced by the number of repeat patient-visits, treatment time-length, rehabilitation-cost and lost work. This paper highlights that the unit cost of each device is simply one factor only to be considered from a number of important cost-elements when assessing the economic impact of treatment options. When the impact of all cost elements are considered, Zero-Cast Wx offers a cost-effective treatment option.


1. Chandra S, Ward P and Mohammadnezhad M (2019) Factors Associated With Patient Satisfaction in Outpatient Department of Suva Sub-divisional Health Center, Fiji, 2018: A Mixed Method Study. Front. Public Health 7:183.doi: 10.3389/fpubh.2019.00183

2. Yann B. Ferrand, Jennifer Siemens, Danny Weathers, Lawrence D. Fredendall, Yunsik Choi, Ronald G. Pirrallo & Matthew Bitner (2016) Patient Satisfaction With Healthcare Services A Critical Review, Quality Management Journal, 23:4, 6-22, DOI: 10.1080/10686967.2016.11918486

3. Prakash B. Patient satisfaction. J Cutan Aesthet Surg. 2010 Sep;3(3):151-5. doi: 10.4103/0974-2077.74491. PMID: 21430827; PMCID: PMC3047732.

4. Firmin F, Crouch R. Splinting versus casting of "torus" fractures to the distal radius in the paediatric patient presenting at the emergency department (ED): a literature review. Int Emerg Nurs. 2009 Jul;17(3):173-8. doi: 10.1016/j.ienj.2009.03.006. Epub 2009 May 7. PMID: 19577205.

5. Williams KG, Smith G, Luhmann SJ, Mao J, Gunn JD 3rd, Luhmann JD. A randomized controlled trial of cast versus splint for distal radial buckle fracture: an evaluation of satisfaction, convenience, and preference. Pediatr Emerg Care. 2013 May;29(5):555-9. doi: 10.1097/PEC.0b013e31828e56fb. PMID: 23603644.

6. Swart E, Tulipan J, Rosenwasser MP. How Should the Treatment Costs of Distal Radius Fractures Be Measured? Am J Orthop (Belle Mead NJ). 2017 Jan/Feb;46(1):E54-E59. PMID: 28235121.


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