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A randomized trial of 'soft cast' for distal radius buckle fractures in children
Khalid Sarwar Khan1, Aidan Grufferty, Olga Gallagher
1Our Lady's Hospital for Sick Children, Dublin, Ireland. khalidskhan2003@yahoo.co.uk
Insights
Soft casts offer a safe and effective treatment for pediatric buckle fractures of the distal radius. This approach leads to high parent satisfaction and fewer complications compared to rigid casts, reducing clinic visits.
Area of Science:
- Orthopedics
- Pediatric Traumatology
- Radiology
Background:
- Buckle fractures, characterized by dorsal cortex compression of the distal radius, are common in children.
- Current treatment protocols often involve rigid casting, necessitating clinic visits for cast removal.
Purpose of the Study:
- To compare the efficacy and safety of soft casts versus rigid casts for treating pediatric buckle fractures.
- To assess patient recovery, parental satisfaction, and complication rates between the two treatment groups.
Main Methods:
- A prospective randomized study involving 117 children with distal radius buckle fractures.
- Patients were assigned to either a soft cast group (home cast removal) or a rigid cast group (clinic cast removal).
- Outcomes were evaluated through clinic follow-up and telephone assessment of recovery and satisfaction.
Main Results:
- Both soft and rigid casts resulted in full recovery, with no significant differences compared to the uninjured side.
- The soft cast group reported fewer problems (1 vs. 5) than the rigid cast group (p = 0.035).
- Parents overwhelmingly preferred soft casts for future treatment (p < 0.01).
Conclusions:
- Soft casts provide a safe and effective alternative for treating pediatric buckle fractures of the distal radius.
- This method reduces the need for fracture clinic appointments and is preferred by parents.
- Soft cast treatment is associated with a lower complication rate compared to rigid casts.
Abstract:
A buckle fracture is a stable fracture where there is a dorsal cortex compression of the distal radius. A total of 117 children with buckle fracture treated at our institution were randomised prospectively into two treatment groups: soft cast or rigid cast. The rigid cast group attended clinic after three weeks for removal of the cast. In the soft cast group, the cast was removed by parents at home after three weeks. Telephone follow-up was carried out after 4 to 5 weeks post fracture. Both groups had full recovery as compared to the uninjured side and parents were satisfied with the treatment. Only one patient in the soft cast group had a problem as compared to 5 in the rigid cast group (p = 0.035, using chi square test). When given a choice, parents of children in both groups opted for future treatment with a soft cast (p < 0.01 using chi square test). Our study showed that buckle fractures of the distal radius can safely be treated with a soft cast without the need for more than one fracture clinic appointment.
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