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Bivalved Versus Circumferential Cast Immobilization for Displaced Forearm Fractures: A Randomized Clinical Trial to
Donald S Bae1, Clarissa Valim, Patricia Connell
1*Department of Orthopaedic Surgery, Boston Children's Hospital †Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA.
Insights
Bivalved and circumferential casts are equally effective for immobilizing pediatric forearm fractures after closed reduction. Both methods show similar rates of maintaining fracture alignment and complication incidence, ensuring good outcomes for children.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Pediatric radius and/or ulna fractures are common injuries.
- Effective immobilization is crucial for maintaining reduction and preventing complications.
- Different casting techniques, bivalved versus circumferential, are used for post-reduction management.
Purpose of the Study:
- To compare the efficacy of bivalved versus circumferential cast immobilization.
- To assess the maintenance of reduction in pediatric forearm fractures.
- To evaluate associated complications following closed reduction.
Main Methods:
- Randomized controlled trial involving 202 children with displaced radius and/or ulna fractures.
- Patients were randomized to either circumferential (n=101) or bivalved (n=101) long-arm casts after closed reduction.
- Clinical and radiographic evaluations were conducted at 1, 2, 4, and 6 weeks postreduction to assess loss of reduction and complications.
Main Results:
- Both cast types effectively reduced fracture angulation.
- No significant differences were observed in radiographic loss of reduction (LOR) rates between bivalved and circumferential casts (34% vs. 34%).
- Remanipulation or surgical fixation rates were similar (23% vs. 24%), with no significant difference in complications like compartment syndrome or neurovascular compromise.
Conclusions:
- Cast immobilization is effective for pediatric forearm fractures post-closed reduction.
- Bivalved and circumferential long-arm casts demonstrate comparable outcomes regarding fracture reduction maintenance and complication rates.
- Both casting methods are suitable for managing pediatric radius and/or ulna fractures.
Background:
The purpose of this study was to determine the effects of bivalved versus circumferential cast immobilization on maintenance of reduction and associated complications after closed reduction (CR) of radius and/or ulna fractures in children.
Methods:
Two hundred two children with displaced radius and/or ulna fractures were randomized to either circumferential (n=101) or bivalved (n=101) long-arm casts after CR. The mean age was 10±3 years. There were no significant differences between groups in terms of age, sex, or initial fracture displacement or angulation. Clinical and radiographic evaluations were performed at 1, 2, 4, and 6 weeks postreduction. Radiographic loss of reduction (LOR), need for remanipulation or surgery, and associated complications of compartment syndrome, cast saw injury, and neurovascular compromise were recorded.
Results:
Overall, the median angulation of the radius and ulna fractures improved from 20 and 18 degrees to 3 and 2 degrees after CR, respectively. The median cast index after reduction was 0.78 in the bivalved group and 0.80 in the circumferential group. The median angulation of the radius and ulna was 8 and 1 degrees at 4 weeks, with no significant difference between groups. By the fourth week of follow-up, 70 patients (34%)-35 bivalved and 35 circumferential-had radiographic LOR. Forty-seven patients (23%)-23 bivalved and 24 circumferential-underwent remanipulation or surgical reduction and fixation. There were no significant differences between groups with respect to LOR rate or need for surgical treatment. One bivalved patient sustained a cast saw injury, and 3 bivalved patients had transient neurological abnormalities. No patients developed compartment syndrome.
Conclusions:
Cast immobilization is effective in the majority of patients after CR of displaced forearm fractures. There were no significant differences in maintenance of reduction, need for surgery, or complications between bivalved or circumferential long-arm casts.
Level Of Evidence:
Level I-therapeutic.
